Healthcare Provider Details

I. General information

NPI: 1134300056
Provider Name (Legal Business Name): STACY L CARNEY L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 OLD BOSTON POST ROAD
DANBURY CT
06810
US

IV. Provider business mailing address

131 OLD BOSTON POST ROAD
DANBURY CT
06810
US

V. Phone/Fax

Practice location:
  • Phone: 800-723-2962
  • Fax: 800-957-5421
Mailing address:
  • Phone: 800-723-2962
  • Fax: 800-957-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number004130
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: