Healthcare Provider Details

I. General information

NPI: 1871924498
Provider Name (Legal Business Name): STACEY HUFFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2013
Last Update Date: 12/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 SILVERSIDE RD SUITE 32
WILMINGTON DE
19810-4916
US

IV. Provider business mailing address

605 MILTON DR
WILMINGTON DE
19802-1116
US

V. Phone/Fax

Practice location:
  • Phone: 302-559-8885
  • Fax:
Mailing address:
  • Phone: 302-559-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001249
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: