Healthcare Provider Details

I. General information

NPI: 1083948533
Provider Name (Legal Business Name): DR STACEY A HANCOCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11925 PEARL RD STE 306A
STRONGSVILLE OH
44136-3343
US

IV. Provider business mailing address

PO BOX 5254
POLAND OH
44514-0254
US

V. Phone/Fax

Practice location:
  • Phone: 440-554-5661
  • Fax: 330-776-5557
Mailing address:
  • Phone: 330-520-2221
  • Fax: 330-776-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6098
License Number StateOH

VIII. Authorized Official

Name: STACEY A HANCOCK
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 440-554-5661