Provider Demographics
NPI:1992173694
Name:LEFEVER, STACEY LEIGH (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LEIGH
Last Name:LEFEVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:LEIGH
Other - Last Name:GRAYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 428 VIREO VITA THERAPY PLLC
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-949-6668
Mailing Address - Fax:717-390-1812
Practice Address - Street 1:102 STONINGTON RD
Practice Address - Street 2:APT A305
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-949-6668
Practice Address - Fax:717-390-1812
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130917104100000X
CT113861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker