| Stacie Thaw Lcsw Pllc | |
|
115 Park Ave. Manhasset NY 11030 | |
| (516) 316-1648 | |
| (516) 365-0180 |
| Full Name | Stacie Thaw Lcsw Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 115 Park Ave., Manhasset, New York |
| Authorized Official Name and Position | Stacie Thaw (LCSW) |
| Authorized Official Contact | 5163161648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacie Thaw Lcsw Pllc 115 Park Ave. Manhasset NY 11030 Ph: (516) 316-1648 | Stacie Thaw Lcsw Pllc 115 Park Ave. Manhasset NY 11030 Ph: (516) 316-1648 |
| NPI Number | 1891167458 |
|---|---|
| Provider Enumeration Date | 10/22/2015 |
| Last Update Date | 10/22/2015 |
| Medicare PECOS PAC ID | 8123309028 |
|---|---|
| Medicare Enrollment ID | O20170109002002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891167458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 078176 (New York) | Primary |
| Provider Name | Stacie E Thaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043451818 PECOS PAC ID: 3274856935 Enrollment ID: I20150105000491 |
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