Provider Demographics
NPI:1538350350
Name:FARRADAY, STACEY L (LPCMH)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:FARRADAY
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CHAPMAN RD
Mailing Address - Street 2:SUITE 203-A
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5490
Mailing Address - Country:US
Mailing Address - Phone:302-981-2750
Mailing Address - Fax:302-294-6258
Practice Address - Street 1:260 CHAPMAN RD
Practice Address - Street 2:SUITE 203-A
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5490
Practice Address - Country:US
Practice Address - Phone:302-981-2750
Practice Address - Fax:302-294-6258
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional