Provider Demographics
NPI:1295903375
Name:DUTKA, STACY LYNN
Entity type:Individual
Prefix:MISS
First Name:STACY
Middle Name:LYNN
Last Name:DUTKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 STRYKER CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1671
Mailing Address - Country:US
Mailing Address - Phone:856-297-7081
Mailing Address - Fax:
Practice Address - Street 1:130 POWERVILLE RD
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-8705
Practice Address - Country:US
Practice Address - Phone:973-316-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)