1699062836 NPI number — MRS. STACEY DAHN LOSARDO LCSW

Table of content: MRS. STACEY DAHN LOSARDO LCSW (NPI 1699062836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699062836 NPI number — MRS. STACEY DAHN LOSARDO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOSARDO
Provider First Name:
STACEY
Provider Middle Name:
DAHN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699062836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1087 SW WOODCREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34990-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-485-9306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3577 SW CORPORATE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34990-8153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-220-3439
Provider Business Practice Location Address Fax Number:
772-220-3484
Provider Enumeration Date:
07/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)