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General NPI Number Information
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NPI Number | 1891167458
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Entity Type | Organization
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Legal Business Name | STACIE THAW LCSW PLLC
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 115 PARK AVE.
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City | MANHASSET
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State | NY
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Zip | 11030
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Country | US
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Telephone | 516-316-1648
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Fax | 516-365-0180
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Provider Business Mailing Address
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Address Line | 115 PARK AVE.
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City | MANHASSET
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State | NY
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Zip | 11030
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Country | US
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Telephone | 516-316-1648
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Fax | 516-365-0180
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Authorized Official
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Title or Position | LCSW
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Name | STACIE THAW
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Credential |
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Telephone | 516-316-1648
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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 | 078176
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License Number State | NY
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