Provider Demographics
NPI:1972637916
Name:JONAS, STACY A (MA, RAS)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:JONAS
Suffix:
Gender:F
Credentials:MA, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CODDINGTOWN CTR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-3537
Mailing Address - Country:US
Mailing Address - Phone:707-565-7655
Mailing Address - Fax:707-565-7661
Practice Address - Street 1:1300 CODDINGTOWN CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-3537
Practice Address - Country:US
Practice Address - Phone:707-565-7655
Practice Address - Fax:707-565-7661
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)