Provider Demographics
NPI:1366714487
Name:ROSSI, STACEY MARIE (LPC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:ROSSI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WAGNER ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9117
Mailing Address - Country:US
Mailing Address - Phone:717-818-4224
Mailing Address - Fax:
Practice Address - Street 1:11 WAGNER ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9117
Practice Address - Country:US
Practice Address - Phone:717-818-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366714487OtherNPI