Provider Demographics
NPI:1306053285
Name:YEARWOOD, STACY MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:MARIE
Last Name:YEARWOOD
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:1 BARSTOW ROAD
Mailing Address - Street 2:STE P24
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-417-4077
Mailing Address - Fax:888-608-9321
Practice Address - Street 1:1 BARSTOW ROAD
Practice Address - Street 2:STE P24
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-417-4077
Practice Address - Fax:888-608-9321
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-09-05
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Provider Licenses
StateLicense IDTaxonomies
NY2462692084P0800X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health