Provider Demographics
NPI:1619588001
Name:STACKOWITZ, ASHLEY ANN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ANN
Last Name:STACKOWITZ
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 LILLIEVILLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:VT
Mailing Address - Zip Code:05032-9719
Mailing Address - Country:US
Mailing Address - Phone:860-617-5835
Mailing Address - Fax:
Practice Address - Street 1:1624 LILLIEVILLE BROOK RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:VT
Practice Address - Zip Code:05032-9719
Practice Address - Country:US
Practice Address - Phone:860-617-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health