Provider Demographics
NPI:1386094134
Name:ANDERSON, STACY (BS, MS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-1803
Mailing Address - Country:US
Mailing Address - Phone:504-304-4097
Mailing Address - Fax:
Practice Address - Street 1:4700 WICHERS DR STE 206
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3054
Practice Address - Country:US
Practice Address - Phone:504-304-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator