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General NPI Number Information
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NPI Number | 1992597819
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Entity Type | Individual
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Provider Name | CHERYL LYNN STACY LCSW. MSW, MPH
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 4821 US HIGHWAY 98 W STE 104
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-8575
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Country | US
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Telephone | 901-290-6368
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Fax |
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Provider Business Mailing Address
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Address Line | 60 MAGNOLIA DR
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City | FREEPORT
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State | FL
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Zip | 32439-3655
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Country | US
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Telephone | 859-419-7696
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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 | SW15212
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License Number State | FL
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