Healthcare Provider Details

I. General information

NPI: 1841023272
Provider Name (Legal Business Name): STACY GHERARDI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 STRYKER RD SE
ALBUQUERQUE NM
87106-7000
US

IV. Provider business mailing address

2631 STRYKER RD SE
ALBUQUERQUE NM
87106-7000
US

V. Phone/Fax

Practice location:
  • Phone: 773-623-9136
  • Fax:
Mailing address:
  • Phone: 773-623-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09802
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: