Provider Demographics
NPI:1982433207
Name:MAITLAND, STACY-ANN M (LMSW)
Entity type:Individual
Prefix:
First Name:STACY-ANN
Middle Name:M
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KNOLLWOOD LN APT 1
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6804
Mailing Address - Country:US
Mailing Address - Phone:845-380-5259
Mailing Address - Fax:
Practice Address - Street 1:263 ROUTE 17K STE 107A
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8345
Practice Address - Country:US
Practice Address - Phone:845-200-9230
Practice Address - Fax:845-622-3504
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099811104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker