Provider Demographics
NPI:1417195579
Name:STARK, AIMEE FRANCINE (MS SPEC ED)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:FRANCINE
Last Name:STARK
Suffix:
Gender:F
Credentials:MS SPEC ED
Other - Prefix:MISS
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:FORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SPEC ED
Mailing Address - Street 1:65 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-1121
Mailing Address - Country:US
Mailing Address - Phone:914-864-0908
Mailing Address - Fax:914-218-8472
Practice Address - Street 1:65 PARK DR
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1121
Practice Address - Country:US
Practice Address - Phone:914-864-0908
Practice Address - Fax:914-218-8472
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041833011103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst