Healthcare Provider Details

I. General information

NPI: 1437067154
Provider Name (Legal Business Name): CARRIE MARIE STACY PPS, SCHOOL PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E BADILLO ST
COVINA CA
91723-2803
US

IV. Provider business mailing address

1347 INDIAN SPRINGS DR
GLENDORA CA
91741-2339
US

V. Phone/Fax

Practice location:
  • Phone: 626-974-7000
  • Fax:
Mailing address:
  • Phone: 626-974-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240147067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: