Provider Demographics
NPI:1770717944
Name:HOLTZ, STACEY LEIGH (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LEIGH
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-1257
Mailing Address - Country:US
Mailing Address - Phone:631-868-3709
Mailing Address - Fax:
Practice Address - Street 1:26 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715-1257
Practice Address - Country:US
Practice Address - Phone:631-868-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator