Individual
JESSICA LAUREN STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
138 W 25TH ST FL 10, NEW YORK, NY 10001-7470
(212) 335-2100
(646) 775-4142
Mailing address
138 W 25TH ST FL 10, NEW YORK, NY 10001-7470
(212) 335-2100
(646) 775-4142
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
LP01739
RI
Other
Enumeration date
07/15/2009
Last updated
02/03/2021
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