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Individual

KRISTEN STACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
675 MAIN ST, MIDDLETOWN, CT 06457-2732
(860) 347-6971
Mailing address
685 FARMINGTON AVE, BERLIN, CT 06037-1350

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
5051
CT
1041C0700X
Clinical Social Worker
Primary
13133
CT

Other

Enumeration date
01/09/2020
Last updated
09/18/2023
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