1689897928 NPI number — STACY STODDARD, LCMFT AND ASSOCIATES, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689897928 NPI number — STACY STODDARD, LCMFT AND ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STACY STODDARD, LCMFT AND ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1689897928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 PROVIDENCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-5503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-583-7443
Provider Business Mailing Address Fax Number:
410-583-0711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286-5503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-583-7443
Provider Business Practice Location Address Fax Number:
410-583-0711
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STODDARD
Authorized Official First Name:
STACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
443-221-0366

Provider Taxonomy Codes

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

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

  • Identifier: KM48 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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