Provider Demographics
NPI:1477699973
Name:STACKS, CAROL RUANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:RUANE
Last Name:STACKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:RUANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:345 E 57TH ST
Mailing Address - Street 2:APT 12B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-605-9963
Mailing Address - Fax:212-759-4889
Practice Address - Street 1:200 W 57 STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-757-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01719411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N14603Medicare ID - Type Unspecified