Basic Information
| Provider Information | |||||||||
| NPI: | 1477059285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAVARD | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 TYNGSBORO RD APT 1 | ||||||||
| Address2: | |||||||||
| City: | DRACUT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018261850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786017139 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018522103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789379700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2018 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 175T00000X | Y |
No ID Information.