Stacie Degeneffe, A.M.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 22418 Issued in CA

Practice address

1240 Powell St Ste 2C
Emeryville, CA 94608

Phone

(510) 384-2088

NPI assigned

Nov 7, 2006

Last updated

Oct 8, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538956800000",
    "number": "1912076746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2633 ACTON ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022348",
            "telephone_number": "510-384-2088",
            "fax_number": "510-384-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 POWELL ST STE 2C",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "94608",
            "telephone_number": "510-384-2088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "378 Van Buren Ave",
            "address_2": "#210",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946104849",
            "country_code": "US",
            "telephone_number": "510-384-2088",
            "fax_number": "510-384-2088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEGENEFFE",
        "first_name": "STACIE",
        "name_prefix": "Ms.",
        "credential": "A.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2018-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "076823",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 22418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Dampier, ED.D
• Uva Sri Dasari
• Sohyila Davani, PSY.D.
• Allison Davis
• Robin Jennifer Davis, DO
• Morgan Delachevrotiere
• Jacquelyn Dellins
• Bejna Demirkol
• David Deng, DPM
• Jade Marie-Jaday Dennis

• Clinical Social Worker in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.