KATHLEEN MARIE STACK (NPI# 1073793675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073793675 |
| Entity Type | Individual |
| Full Name | KATHLEEN MARIE STACK |
| Credential | RDH, MPH |
| Practice Address |
1315 Main St Willimantic CT 06226-1948 |
| Mailing Address |
84 High St #3 Mystic CT 06355-2439 |
| Practice Telephone | 8604507456 |
| Practice Fax Number | 8604234629 |
| Mailing Telephone | 8605140968 |
| Mailing Fax Number | 8604234629 |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2007-11-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 007004 | CT | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013148915 | Kathleen Mary Stack | Speech-Language Pathologist | 1666 Hancock St, Ridgewood, NY 11385 | 2009-07-27 |
| 1548314131 | Kathleen Stack | Social Worker | 189 Montague St, Suite 436, Brooklyn, NY 11201-3610 | 2007-01-22 |
| 1902866718 | Kathleen Marie Stack | Psychiatry & Neurology | 576 Jefferson Ave, Mcdonald Army Health Center, Ft Eustis, VA 23604-5548 | 2006-03-24 |
| Street Address |
1315 MAIN ST |
| City | WILLIMANTIC |
| State | CT |
| Zip Code | 06226-1948 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063495216 | Edgar Daniel Albuja | Pharmacist | 1315 Main St, Willimantic, CT 06226-1948 | 2005-11-22 |
| 1518236975 | Tracy M Gratton | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2011-12-14 |
| 1063794808 | Sheryl Ficorilli | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2011-09-19 |
| 1932389210 | Cheryl A Ceniglio | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2007-11-05 |
| 1912065632 | Mashid Hedayati | Dentist | 1315 Main St, Willimantic, CT 06226-1948 | 2006-12-05 |
| 1235248501 | Margaret Ann Smith | Dentist | 1315 Main St, Willimantic, CT 06226-1948 | 2006-08-30 |
| 1043275548 | Michael S. Goodman | Dentist | 1315 Main St, Willimantic, CT 06226-1948 | 2006-04-18 |
| 1932163870 | Nestor Enrique Torres | Family Medicine | 1315 Main St, Willimantic, CT 06226-1948 | 2006-04-17 |
| 1376513184 | David A. Lamot | Dentist | 1315 Main St, Suite 2, Willimantic, CT 06226-1948 | 2006-01-24 |
| 1992784227 | Diane R. D'ambrosio | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2006-01-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669962163 | Nutmeg Neuropsychology LLC | Psychologist | 322 Main St Ste 2e-1o, Willimantic, CT 06226 | 2018-05-10 |
| 1104344365 | Taylor Girard | Social Worker | 54-56 Boston Post Road, Willimantic, CT 06226 | 2017-09-07 |
| 1194268490 | Donald Diange | Pharmacist | 1391 Main Street, Willimantic, CT 06226 | 2016-11-18 |
| 1386988954 | Gale K Lockland | Psychologist | 112 Mansfield Avenue, Windham Community Memorial Hospital, Willimantic, CT 06226 | 2012-11-20 |
| 1831343060 | Carlita R Baldwin | Counselor | 366 Ash Street, Unit 4, Willimantic, CT 06226 | 2008-11-14 |
| 1023211190 | Joel Lee Reinholtz | Physical Therapy Assistant | 595 Valley Street, Windham, CT 06226 | 2007-06-07 |
| 1265654719 | Mcsweeney Regional Senior Center | Clinic/Center | 47 Crescent St, Willimantic, CT 06226 | 2007-05-03 |
| 1912012964 | John Wescott Stevens | Dentist | 1581 W Main St, Willmantic, CT 06226 | 2006-08-20 |
| 1801802756 | Kathryn Nelson | Family Medicine | 355 High Street, Willimantic, CT 06226 | 2006-07-31 |
| 1710914379 | The Foot Group, LLC | Podiatrist | 162 A Mansfield Ave, Willimantic, CT 06226 | 2006-06-27 |
| Find all providers in zip 06226 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114286176 | Terry Cardinal | Dental Hygienist | 40 Mansfield Ave, Willimantic, CT 06226-2018 | 2012-05-11 |
| 1982979258 | Nicole Ann Bashar | Dental Hygienist | 40 Mansfield Ave, Willimantic, CT 06226-2018 | 2012-03-20 |
| 1518236975 | Tracy M Gratton | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2011-12-14 |
| 1063794808 | Sheryl Ficorilli | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2011-09-19 |
| 1932389210 | Cheryl A Ceniglio | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2007-11-05 |
| 1992784227 | Diane R. D'ambrosio | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2006-01-13 |
| 1093794323 | Pamela J. Young | Dental Hygienist | 1315 Main St, Willimantic, CT 06226-1948 | 2006-01-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346847514 | Lilly Prado | Dental Hygienist | 317 W Preston St, Hartford, CT 06114-2337 | 2020-10-01 |
| 1124657945 | Dorjan Kodra | Dental Hygienist | 78 Chesterfield Ave, Wolcott, CT 06716-3225 | 2020-04-03 |
| 1639728298 | Ashlyn Mucha | Dental Hygienist | 55 Sargent Drive, Bethany, CT 06524-3135 | 2019-09-06 |
| 1245885748 | Michelle Ann Daconto | Dental Hygienist | 16 Backes Ct, Wallingford, CT 06492-4712 | 2019-08-02 |
| 1194378323 | Brittany Varano | Dental Hygienist | 55 Sargent Dr., Bethany, CT 06524 | 2019-07-17 |
| 1922570910 | Jessica Nicoletti | Dental Hygienist | 10 Main St Unit 106, Berlin, CT 06037-2661 | 2019-01-02 |
| 1821569914 | Maria Bianca Pierce | Dental Hygienist | 238 Old Grassy Hill Rd, Orange, CT 06477-2426 | 2018-12-16 |
| 1679058135 | Patricia A Johnson | Dental Hygienist | 271 Scott Swamp Rd, Farmington, CT 06032-3324 | 2018-10-01 |
| 1760964704 | Sheethal Joseph Mathew | Dental Hygienist | 49 South Main Street, Torrington, CT 06790 | 2018-09-06 |
| 1689182842 | Myology Orofacial Therapy LLC | Dental Hygienist | 71 East Ave # Q1, Norwalk, CT 06851-4903 | 2018-01-22 |
| Find all providers with the same taxonomy | ||||
| City | WILLIMANTIC |
| Zip Code | 06226 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.