Stacey Michelle Mack, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801081771 Issued in MI

Practice address

3150 Packard Rd
Ypsilanti, MI 48197-1994

Phone

(734) 879-0162

Fax

(734) 879-0167

NPI assigned

Jun 24, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Stacey Michelle Mack-Cameron Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Intentional Counseling Services

  • Community/Behavioral Health Agency
  • Ypsilanti, MI
  • NPI 1427427814

  Clinical

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1407017239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3150 PACKARD RD",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971994",
            "telephone_number": "734-879-0162",
            "fax_number": "734-879-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 PACKARD RD",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971994",
            "telephone_number": "734-879-0162",
            "fax_number": "734-879-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "STACEY",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801081771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "MACK-CAMERON",
            "middle_name": "MICHELLE",
            "prefix": "MS.",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lynn Rebekah Maas, CCC-SLP
• Kelly Megan Macarthur, D.D.S.
• Philip Stafford Romine Macbride, PA-C
• Knox Simba Machamire
• Rachel Therese Mack, NP
• Stephanie M Mackenzie, DO
• Taylor Ann Mackenzie, BSW
• Terri Lou Mackenzie, LMSW
• Catherine Danielle Mackey
• Niklas Joakim Mackler, MD

• Clinical Social Worker in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.