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Individual
MRS. ELLEN STARK
Active
Individual
MRS. ELLEN STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
44SL04303600
NJ
Other
Enumeration date
02/13/2012
Last updated
02/13/2012
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