Individual
MS. KEYONIA S STACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
184 ELDRIDGE ST, NEW YORK, NY 10002-2924
(212) 453-4522
Mailing address
33 EAGLE ST APT 2J, BROOKLYN, NY 11222-6065
(484) 862-2406
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
29698163
PA
Other
Enumeration date
06/26/2019
Last updated
06/26/2019
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