Individual
DARRA LYNN STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
81 NAUTILUS DR, MANAHAWKIN, NJ 08050-2448
(732) 966-4166
Mailing address
65 OXYCOCUS RD, MANAHAWKIN, NJ 08050-2939
(609) 548-8841
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SL06415500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15169130
CAQH
NJ
Enumeration date
06/24/2021
Last updated
06/24/2021
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