Provider Demographics
NPI:1225861834
Name:WRIGHT, STACIA (BS)
Entity type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-0120
Mailing Address - Country:US
Mailing Address - Phone:860-437-4550
Mailing Address - Fax:860-661-4262
Practice Address - Street 1:4 GROVE BEACH RD N STE 2D
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-1656
Practice Address - Country:US
Practice Address - Phone:860-437-4550
Practice Address - Fax:860-661-4262
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical