Provider Demographics
NPI:1447413596
Name:MUOLO, STACEE J (LCSW, CASAC2)
Entity type:Individual
Prefix:
First Name:STACEE
Middle Name:J
Last Name:MUOLO
Suffix:
Gender:F
Credentials:LCSW, CASAC2
Other - Prefix:
Other - First Name:STACEE
Other - Middle Name:J
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 LEICESTER ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14530-1139
Mailing Address - Country:US
Mailing Address - Phone:585-689-5695
Mailing Address - Fax:
Practice Address - Street 1:36 LEICESTER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530-1139
Practice Address - Country:US
Practice Address - Phone:585-689-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094632104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor