Provider Demographics
NPI:1083491211
Name:STARK, HERSHY (MS ED)
Entity Type:Individual
Prefix:
First Name:HERSHY
Middle Name:
Last Name:STARK
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HORIZON CT UNIT 301
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-7810
Mailing Address - Country:US
Mailing Address - Phone:845-243-1715
Mailing Address - Fax:
Practice Address - Street 1:4 HORIZON CT UNIT 301
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-7810
Practice Address - Country:US
Practice Address - Phone:845-243-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP121012103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst