| NPI | 1588814461 |
|---|---|
| Former Name | STACY ANN LICKLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006183A) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2016-08-17 |