Provider Demographics
NPI:1386890218
Name:FOSKETT, STACEY MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MARIE
Last Name:FOSKETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1567
Mailing Address - Country:US
Mailing Address - Phone:508-273-3614
Mailing Address - Fax:
Practice Address - Street 1:16 CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1567
Practice Address - Country:US
Practice Address - Phone:508-273-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health