MEDICARE: STACY JEANNE LENNY LICSW, CDP, ACHT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP60334982	WA
2	1041C0700X	Clinical Social Worker	LW60918606	WA

General Provider Information

NPI Number	:	1275785230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY JEANNE LENNY LICSW, CDP, ACHT

Provider Business Mailing Address
First Line	:	1314 NE 43RD ST STE 213
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5832
Country	:	US
Telephone Number	:	206-947-1123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 NE 43RD ST STE 213
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105
Country	:	US
Telephone Number	:	206-947-1123
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	08/19/2019

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