Basic Information
| Provider Information | |||||||||
| NPI: | 1598896888 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WECKWERTH | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | FAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A, L.M.H.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 HALL ROAD | ||||||||
| Address2: | NUMBER 6 | ||||||||
| City: | STURBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083209097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 29 PINE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015501823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087659167 | ||||||||
| FaxNumber: | 5087642462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 02/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6125 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.