Provider Demographics
NPI:1407020332
Name:STACK, CECELIA A (MED)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:A
Last Name:STACK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2633
Mailing Address - Country:US
Mailing Address - Phone:412-675-8533
Mailing Address - Fax:412-675-8920
Practice Address - Street 1:332 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2633
Practice Address - Country:US
Practice Address - Phone:412-675-8533
Practice Address - Fax:412-675-8920
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health