Provider Demographics
NPI:1548535313
Name:MARKMAN, STACY R (LPCMH, NCC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:MARKMAN
Suffix:
Gender:F
Credentials:LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MALLBORO DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1531
Mailing Address - Country:US
Mailing Address - Phone:302-354-0124
Mailing Address - Fax:
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:STE 204
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-832-1282
Practice Address - Fax:302-832-7313
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional