Staci Abby, LCAT

Primary specialty

Drama TherapistTaxonomy code 101200000X

License

002410-01 Issued in NY

Practice address

2503 32ND St
Astoria, NY 11102-5011

Phone

(205) 639-9304

NPI assigned

Oct 17, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Staci Jacobson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Balance Eating Disorder Center LLC

  • Mental Illness Intermediate Care Facility
  • New York, NY
  • NPI 1467029587
  NPD (past)

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

{
    "created_epoch": "1665964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1275259665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2503 32ND ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111025011",
            "telephone_number": "205-639-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2503 32ND ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111025011",
            "telephone_number": "205-639-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABBY",
        "first_name": "STACI",
        "credential": "LCAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NY",
            "license": "002410",
            "primary": false
        },
        {
            "code": "101200000X",
            "taxonomy_group": "",
            "desc": "Drama Therapist",
            "state": "NY",
            "license": "002410-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "JACOBSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Astoria, NY
• Drama Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.