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Individual
STACEY M PURRO
Active
Individual
STACEY M PURRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R046672
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID ID
NY
01
—
1285628552
AGENCY NPI #
NY
01
—
WVE061
AGENCY MEDICARE ID
NY
Enumeration date
09/23/2009
Last updated
09/23/2009
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