Roosevelt Stacy, LCSW-S, LMFT-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

50557 Issued in TX

Practice address

1002 E Stadium Dr
Rosenberg, TX 77471-2579

Phone

(281) 762-8383

Fax

(281) 762-8355

NPI assigned

Aug 19, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Memorial Hermann Community Benefit Corporation

  dba Memorial Hermann Health Centers for Schools--Lamar Clinic

  • Primary Care Clinic/Center
  • Rosenberg, TX
  • NPI 1740799980
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1093820490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 E STADIUM DR",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774712579",
            "telephone_number": "281-762-8383",
            "fax_number": "281-762-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 E STADIUM DR",
            "city": "ROSENBERG",
            "state": "TX",
            "postal_code": "774712579",
            "telephone_number": "281-762-8383",
            "fax_number": "281-762-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "ROOSEVELT",
        "credential": "LCSW-S, LMFT-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2022-07-21",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "50557",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "4979",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Spragins, O.D.
• SRM Urgent Care PLLC
• St Michael's Pharmacy LLC
• St. Patrick Health Services Inc.
• St. Patrick Health Services, Inc
• Stephanie Lynn Stage, M.ED.
• Step-in Clinics LLC (step-in clinics)
• Latristaca Stephens
• Charmaine Michelle Stetson, OWNER
• Natalie Brooke Stevens

• Clinical Social Worker in Rosenberg, TX
• Providers in Rosenberg, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.