Provider Demographics
NPI:1871829572
Name:KING, STUART (LSW, LCADC, DMIN)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:LSW, LCADC, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01022-1534
Mailing Address - Country:US
Mailing Address - Phone:732-675-5311
Mailing Address - Fax:
Practice Address - Street 1:390 WALKER AVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01022-1534
Practice Address - Country:US
Practice Address - Phone:413-557-2623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00120800101YA0400X
NJ44SL01175800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)