| Organization Name: | STACEY BLAUTH, LPC LCADC |
| NPI Number: | 1871843813 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA BLANCHETTTE (OFFICE MANAGER) |
| Mailing Address: | 500 Main St Bldg 2 Lanoka Harbor |
| State: | NJ US |
| Postal Code: | 087342228 |
| Phone Number: | 6099718989 |
| Fax Number: | 6092423207 |
| NPI Enumeration Date: | 09/18/2012 |
| NPI Last Update Date: | 09/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 37PC00350900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |