MEDICARE: STACI ABBY LCAT

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	101Y00000X	Counselor	002410	NY
2	101200000X	Drama Therapist	002410-01	NY

General Provider Information

NPI Number	:	1275259665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI ABBY LCAT

Provider Business Mailing Address
First Line	:	2503 32ND ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-5011
Country	:	US
Telephone Number	:	205-639-9304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 32ND ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-5011
Country	:	US
Telephone Number	:	205-639-9304
Fax Number	:

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

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	07/17/2024

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Directions to “ STACI ABBY LCAT” Practice Location

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