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General NPI Number Information
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NPI Number | 1457001497
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Entity Type | Individual
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Provider Name | STACEY VINCENT LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 215 LAKE POINTE DR
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City | OAKLAND PARK
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State | FL
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Zip | 33309-3588
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Country | US
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Telephone | 954-990-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 1377 NW 40TH AVE # 1046
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City | LAUDERHILL
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State | FL
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Zip | 33313-5803
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Country | US
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Telephone |
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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 | SW18857
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License Number State | FL
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