Provider Demographics
NPI:1538350350
Name:FARRADAY, STACEY L (LPCMH)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:FARRADAY
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OLIVINE CIR
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2001
Mailing Address - Country:US
Mailing Address - Phone:302-373-8005
Mailing Address - Fax:888-830-5523
Practice Address - Street 1:110 OLIVINE CIR
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-2001
Practice Address - Country:US
Practice Address - Phone:302-373-8005
Practice Address - Fax:888-830-5523
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000414101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional