Individual provider Active NPI

Stacey L Rossano, LICSW

  • Clinical Social Worker
  • West Springfield, MA
National Provider Identifier
1184657991
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
113208 Issued in MA
Practice address
1132 Westfield St
West Springfield, MA 01089-3878
Phone
(413) 592-1980
Fax
(413) 439-0096
NPI assigned
Jul 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 113208 MA Primary

Addresses

Primary practice location

1132 Westfield St
West Springfield, MA 01089-3878

Mailing address

44 Plaza Ave
Belchertown, MA 01007-8800
Phone (413) 323-0194

Other identifiers 1

IdentifierTypeStateIssuer
62-00478OtherMAEVERCARE

Other names 1

  • Miss Stacey L Clark Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050829001076 MA Practitioner - Clinical Social Worker 4183655129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthdrive Behavioral Health Services, PLLCGroup PAC ID 8729345822, 89 clinicians

Practice addresses (Care Compare)

100 Crossing Blvd
Suite 300
Framingham, MA 01702-5555
Phone (888) 964-6681

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Healthdrive Behavioral Health Services, PLLC Clinical CurrentSince Oct 1, 2021 Accepting new patients

Locations

100 Crossing Blvd
Ste 300
Framingham, MA 01702
Phone (857) 255-0486

103 Myron St
Ste A
West Springfield, MA 01089
Phone (978) 388-1010

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184657991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 PLAZA AVE",
            "city": "BELCHERTOWN",
            "state": "MA",
            "postal_code": "010078800",
            "telephone_number": "413-323-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 WESTFIELD ST",
            "city": "WEST SPRINGFIELD",
            "state": "MA",
            "postal_code": "010893878",
            "telephone_number": "413-592-1980",
            "fax_number": "413-439-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSSANO",
        "first_name": "STACEY",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "62-00478",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "CLARK",
            "middle_name": "L",
            "prefix": "MISS",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Springfield, MA

Sources for this page

Verify at the official NPI Registry.