Provider Demographics
NPI:1568688091
Name:STARK, DEBORAH LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:STARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 EAST 86TH ST
Mailing Address - Street 2:APT 22A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-744-2912
Mailing Address - Fax:212-744-0293
Practice Address - Street 1:19 WEST 34TH ST PH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-744-2912
Practice Address - Fax:212-744-0293
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY230944POtherHIP
NY02768138Medicaid
NYV833CIMedicare ID - Type Unspecified