Provider Demographics
NPI:1548047210
Name:MAISE, STACYANN (PSYD)
Entity type:Individual
Prefix:
First Name:STACYANN
Middle Name:
Last Name:MAISE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:STACYANN
Other - Middle Name:
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:198 CREAM ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6316
Mailing Address - Country:US
Mailing Address - Phone:860-670-9183
Mailing Address - Fax:
Practice Address - Street 1:10 ROSS CIR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1078
Practice Address - Country:US
Practice Address - Phone:845-454-4906
Practice Address - Fax:845-483-3268
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist