Individual
STACY MELISSA ISHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
475 CLINTON AVE, BRIDGEPORT, CT 06605-1700
(203) 368-5500
Mailing address
475 CLINTON AVE, BRIDGEPORT, CT 06605-1700
(203) 368-5500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5029
CT
101YP2500X
Professional Counselor
Primary
5029
CT
Other
Enumeration date
12/02/2021
Last updated
12/02/2021
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