Provider Demographics
NPI:1871798744
Name:SOLOMON, STACEY MICHELLE (LPC)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MICHELLE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CARNEGIE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-3101
Mailing Address - Country:US
Mailing Address - Phone:732-859-0905
Mailing Address - Fax:
Practice Address - Street 1:41 CARNEGIE CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3101
Practice Address - Country:US
Practice Address - Phone:732-859-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00292300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional