Provider Demographics
NPI:1447717558
Name:WYTHE, STACIE MARIE (MSW)
Entity type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:MARIE
Last Name:WYTHE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WESTWAY
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2132
Mailing Address - Country:US
Mailing Address - Phone:781-223-7924
Mailing Address - Fax:
Practice Address - Street 1:7 WESTWAY
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2132
Practice Address - Country:US
Practice Address - Phone:781-223-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program