Provider Demographics
NPI:1124266085
Name:SINGH, STACIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:SINGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 N PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1800
Mailing Address - Country:US
Mailing Address - Phone:909-824-0480
Mailing Address - Fax:
Practice Address - Street 1:791 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1800
Practice Address - Country:US
Practice Address - Phone:909-824-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2024-05-06
Deactivation Date:2012-04-13
Deactivation Code:
Reactivation Date:2014-12-01
Provider Licenses
StateLicense IDTaxonomies
CA613831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty