Individual
DR. DEBORAH JEAN STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
682 PROSPECT AVENUE, HARTFORD, CT 06105
(860) 258-6065
(860) 232-5077
Mailing address
682 PROSPECT AVENUE, HARTFORD, CT 06105
(860) 258-6065
(860) 232-5077
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1238
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060001238CT01
BCBS
CT
01
—
HAS394
OXFORD
CT
Enumeration date
11/01/2006
Last updated
07/08/2007
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