MEDICARE: LINDA STACEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW6621	FL

General Provider Information

NPI Number	:	1245566827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA STACEY LCSW

Provider Business Mailing Address
First Line	:	3108 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3059
Country	:	US
Telephone Number	:	813-673-4646
Fax Number	:	813-673-4644

Provider Business Practice Location Address
First Line	:	3108 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3059
Country	:	US
Telephone Number	:	813-673-4646
Fax Number	:	813-673-4644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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