Provider Demographics
NPI:1285084822
Name:STARK, ALLANA FREDERICKA (LMSW, JD)
Entity type:Individual
Prefix:MS
First Name:ALLANA
Middle Name:FREDERICKA
Last Name:STARK
Suffix:
Gender:F
Credentials:LMSW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2342
Mailing Address - Country:US
Mailing Address - Phone:917-848-0379
Mailing Address - Fax:212-486-9345
Practice Address - Street 1:1841 BROADWAY FL 4
Practice Address - Street 2:INSTITUTE FOR CONTEMPORARY PSYCHOTHERAPY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-333-3444
Practice Address - Fax:212-333-5444
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 097780104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker