Organization
SOUTHBURY ADOLESCENT AND YOUNG ADULT COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENDAN STACK LPC (OWNER, LPC)
(518) 610-4528
Entity
Organization
Contact information
Practice address
519 HERITAGE RD STE 2A5, SOUTHBURY, CT 06488-6694
(203) 568-5923
Mailing address
127 WATERTOWN RD, MIDDLEBURY, CT 06762-1502
(518) 610-4528
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/15/2020
Last updated
08/03/2025
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