Healthcare Provider Details

I. General information

NPI: 1447849054
Provider Name (Legal Business Name): STACEY REBECCA HUTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HILLSIDE AVE
NAUGATUCK CT
06770-4019
US

IV. Provider business mailing address

16 HILLSIDE AVE
NAUGATUCK CT
06770-4019
US

V. Phone/Fax

Practice location:
  • Phone: 203-729-0341
  • Fax:
Mailing address:
  • Phone: 516-732-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14999
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: