Provider Demographics
NPI:1801457544
Name:SHIRER-SMITH, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SHIRER-SMITH
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 1:169 OAKS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717
Mailing Address - Country:US
Mailing Address - Phone:724-963-4550
Mailing Address - Fax:
Practice Address - Street 1:169 OAKS POINT RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717
Practice Address - Country:US
Practice Address - Phone:724-963-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst