| Stacey Rosas Lcsw Pllc | |
|
5224 Moon Shadow Dr Austin TX 78735-6015 | |
| (512) 587-1107 | |
| Not Available |
| Full Name | Stacey Rosas Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 5224 Moon Shadow Dr, Austin, Texas |
| Authorized Official Name and Position | Stacey Hilts Rosas (OWNER) |
| Authorized Official Contact | 5125871107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey Rosas Lcsw Pllc 5224 Moon Shadow Dr Austin TX 78735-6015 Ph: (512) 587-1107 | Stacey Rosas Lcsw Pllc 5224 Moon Shadow Dr Austin TX 78735-6015 Ph: (512) 587-1107 |
| NPI Number | 1962035972 |
|---|---|
| Provider Enumeration Date | 02/18/2020 |
| Last Update Date | 05/10/2023 |
| Certification Date | 05/10/2023 |
| Medicare PECOS PAC ID | 3779906102 |
|---|---|
| Medicare Enrollment ID | O20200702000112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962035972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stacey H Rosas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275824591 PECOS PAC ID: 0244408763 Enrollment ID: I20110727000315 |
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