Healthcare Provider Details

I. General information

NPI: 1770823882
Provider Name (Legal Business Name): WENDY STACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 FAUCE CORNER RD.
N. DARTMOUTH MA
02747
US

IV. Provider business mailing address

24 BAILEY CT
HAVERHILL MA
01832-1002
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax: 774-628-9657
Mailing address:
  • Phone: 978-374-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: