National Provider Identifier
Jason Stark, LCSW
Jason Stark, LCSW is listed in the NPPES registry with a primary specialty of Clinical Social Worker in Ithaca, NY and a listed phone number of (607) 592-2377.
Profile Overview
- NPI
- 1609998574
- Provider Type
- Individual
- Primary Specialty
- Clinical Social Worker
- Enumeration Date
- April 04, 2007
- Last Updated
- July 07, 2023
Practice Location
- 903 Hanshaw RD
- Ithaca, NY 14850-1530
Phone: (607) 592-2377
Specialties
- Clinical Social Worker (1041C0700X)
Full Record
- NPI
- 1609998574
- Entity Type
- Individual
- Last Name
- Stark
- First Name
- Jason
- Credential
- LCSW
- Mailing Street Address
- 903 Hanshaw RD
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-1530
- Mailing Country
- US
- Mailing Phone
- (607) 592-2377
- Practice Street Address
- 903 Hanshaw RD
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-1530
- Practice Country
- US
- Practice Phone
- (607) 592-2377
- Enumeration Date
- April 04, 2007
- Last Updated
- July 07, 2023
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- July 07, 2023
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Clinical Social Worker (1041C0700X)
- Other Identifiers
- 079191-1 (NY, Nys), 082965 (NY, Lcsw)