Provider Demographics
NPI:1730267923
Name:BARNES, STACIE JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:JEAN
Last Name:BARNES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:JEAN
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15779-0111
Mailing Address - Country:US
Mailing Address - Phone:724-675-2011
Mailing Address - Fax:
Practice Address - Street 1:121 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779-0111
Practice Address - Country:US
Practice Address - Phone:724-675-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3030103TC0700X
PAPS016440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical