Provider Demographics
NPI:1992439285
Name:DUMEZIL, STACEY
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:DUMEZIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5382
Mailing Address - Country:US
Mailing Address - Phone:978-602-2902
Mailing Address - Fax:
Practice Address - Street 1:1 WAVERLY ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5382
Practice Address - Country:US
Practice Address - Phone:978-602-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst