Individual
MR. BRENDAN STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LADC
Contact information
Practice address
519 HERITAGE RD STE 2A5, SOUTHBURY, CT 06488-6694
(518) 610-4528
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
001323
CT
101YP2500X
Professional Counselor
Primary
4530
CT
Other
Enumeration date
02/20/2019
Last updated
07/18/2025
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