Individual
MISS AMY MARIE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
70 PINE ST, WATERBURY, CT 06710-2169
(203) 597-1935
(203) 597-8711
Mailing address
70 PINE ST, WATERBURY, CT 06710-2169
(203) 597-1935
(203) 597-8711
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
001599
CT
Other
Enumeration date
05/11/2009
Last updated
05/11/2009
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