Individual
MS. STACY MARIE STACKROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
585 LINCOLN ST, WORCESTER, MA 01605-1906
(508) 854-3320
(508) 753-5051
Mailing address
585 LINCOLN ST, WORCESTER, MA 01605-1906
(508) 854-3320
(508) 753-5051
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306421
—
MA
05
—
1308785
—
MA
01
—
2220002001
BCBS SUBSTANCE ABUSE
MA
01
—
M18684
BCBS MENTAL HEALTH
MA
Enumeration date
01/18/2007
Last updated
07/09/2007
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