Provider Demographics
NPI:1700096831
Name:BRAIUCA, STACY LYNETTE (MSW,MPH,LCSW,LSCSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNETTE
Last Name:BRAIUCA
Suffix:
Gender:F
Credentials:MSW,MPH,LCSW,LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SW GREENWICH DR # 804
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4408
Mailing Address - Country:US
Mailing Address - Phone:866-393-4242
Mailing Address - Fax:
Practice Address - Street 1:1300 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4264
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21621041C0700X
MN338441041C0700X
AR12439-C1041C0700X
MO19991379931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical