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General NPI Number Information
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NPI Number | 1366968414
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Entity Type | Individual
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Provider Name | STACIE KATHERINE TRANTALIS MSW
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 708 NE 6TH ST
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-3704
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Country | US
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Telephone | 352-804-2953
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Fax |
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Provider Business Mailing Address
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Address Line | 8142 W MISS MAGGIE DR
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City | HOMOSASSA
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State | FL
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Zip | 34448-5303
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Country | US
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Telephone | 860-692-4745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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