Individual
MRS. AMY STACK GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMHC
Contact information
Practice address
251 LAFAYETTE ST FL 3, NEW YORK, NY 10012-4067
(212) 570-1693
Mailing address
3726 HILAIRE WAY, SEAFORD, NY 11783-2710
(718) 352-2140
(718) 352-2491
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002405-1
NY
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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