Provider Demographics
NPI:1780948349
Name:PLAIN, STACEY LYNN (MSED, NCSP)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:PLAIN
Suffix:
Gender:F
Credentials:MSED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LYNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2422
Mailing Address - Country:US
Mailing Address - Phone:845-598-0226
Mailing Address - Fax:
Practice Address - Street 1:1 LYNHAVEN DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2422
Practice Address - Country:US
Practice Address - Phone:845-598-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency