Provider Demographics
NPI:1255939872
Name:PICARD, STACY ELIZABETH (MS SCHOOL PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ELIZABETH
Last Name:PICARD
Suffix:
Gender:F
Credentials:MS SCHOOL PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1523
Mailing Address - Country:US
Mailing Address - Phone:603-843-7542
Mailing Address - Fax:
Practice Address - Street 1:4 MARSTON WAY
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2055
Practice Address - Country:US
Practice Address - Phone:603-926-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH92273103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool