Provider Demographics
NPI:1043525330
Name:BOBER, STACY NADINE (LMSW)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:NADINE
Last Name:BOBER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:NADINE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1376 N FARM ROAD 227
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65757
Mailing Address - Country:US
Mailing Address - Phone:417-631-1666
Mailing Address - Fax:
Practice Address - Street 1:1376 N FARM ROAD 227
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65757
Practice Address - Country:US
Practice Address - Phone:417-631-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONONE101YA0400X
MO20110020741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)