MEDICARE: STACEY CASTELLUCCI MSW, LSW

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	104100000X	Social Worker	S.2613577	OH

General Provider Information

NPI Number	:	1669256509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY CASTELLUCCI MSW, LSW

Provider Business Mailing Address
First Line	:	2587 BACK ORRVILLE RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691-9523
Country	:	US
Telephone Number	:	330-264-9597
Fax Number	:	330-264-0964

Provider Business Practice Location Address
First Line	:	2587 BACK ORRVILLE RD
Second Line	:
City	:	WOOSTER
State	:	OH
Zip	:	44691
Country	:	US
Telephone Number	:	330-264-9597
Fax Number	:

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	03/17/2026

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