Healthcare Provider Details

I. General information

NPI: 1609279603
Provider Name (Legal Business Name): STACEY GUERRIERI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACEY LOVEJOY LCSW

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 MAIN STREET, SUITE 2
METUCHEN NJ
08840-1918
US

IV. Provider business mailing address

283 MAIN STREET, SUITE 2
METUCHEN NJ
08840-1918
US

V. Phone/Fax

Practice location:
  • Phone: 732-239-5746
  • Fax:
Mailing address:
  • Phone: 732-239-5746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05514300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number596501
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: