Healthcare Provider Details

I. General information

NPI: 1598518532
Provider Name (Legal Business Name): STACEY TSAI YEE ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3585 MAPLE ST STE 246
VENTURA CA
93003-9104
US

IV. Provider business mailing address

400 FOREST PARK BLVD APT 230
OXNARD CA
93036-5549
US

V. Phone/Fax

Practice location:
  • Phone: 805-625-2244
  • Fax:
Mailing address:
  • Phone: 408-375-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: