Provider Demographics
NPI:1053414391
Name:LANDESBERG, STACY LEE (MED, PCC-S)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LEE
Last Name:LANDESBERG
Suffix:
Gender:F
Credentials:MED, PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8323 ARBORCREST DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1403
Mailing Address - Country:US
Mailing Address - Phone:513-792-0160
Mailing Address - Fax:
Practice Address - Street 1:311 ALBERT SABIN WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2838
Practice Address - Country:US
Practice Address - Phone:513-558-6649
Practice Address - Fax:513-558-3100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3969101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional