Provider Demographics
NPI:1669596102
Name:STARK, DEBBIE M
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:M
Last Name:STARK
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 1:201 W 109TH STREET, #4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:917-686-5707
Mailing Address - Fax:212-749-0738
Practice Address - Street 1:915 WEST END AVENUE, #1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:917-686-5707
Practice Address - Fax:212-749-0735
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical