Provider Demographics
NPI:1528780079
Name:DUTIL, STACEY (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:DUTIL
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KRAKOW ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1427
Mailing Address - Country:US
Mailing Address - Phone:347-463-5297
Mailing Address - Fax:
Practice Address - Street 1:70 KRAKOW ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1427
Practice Address - Country:US
Practice Address - Phone:347-463-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060253001041C0700X
NY0881761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical