MICHELLE ELENA STACK (NPI# 1952671950) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952671950 |
| Entity Type | Individual |
| Full Name | MICHELLE ELENA STACK |
| Credential | PH.D. |
| Practice Address |
75 Kings Highway Cutoff Fairfield CT 06824-5340 |
| Practice Telephone | 2033331133 |
| Practice Fax Number | 2033333937 |
| Mailing Telephone | 2033331133 |
| Mailing Fax Number | 2033333937 |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-09-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 3230 | CT | Behavioral Health & Social Service Providers |
| N | 103G00000X | Clinical Neuropsychologist | 1195 | NM | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | 3230 | CT | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | 1195 | NM | Behavioral Health & Social Service Providers |
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
3230 | CT | Behavioral Health & Social Service Providers |
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
1195 | NM | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
3230 | CT | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
1195 | NM | Behavioral Health & Social Service Providers |
| N | 103TR0400X |
Psychologist Specialization: Rehabilitation |
3230 | CT | Behavioral Health & Social Service Providers |
| N | 103TR0400X |
Psychologist Specialization: Rehabilitation |
1195 | NM | Behavioral Health & Social Service Providers |
| N | 103TH0004X |
Psychologist Specialization: Health |
1195 | NM | Behavioral Health & Social Service Providers |
| Street Address |
75 KINGS HIGHWAY CUTOFF |
| City | FAIRFIELD |
| State | CT |
| Zip Code | 06824-5340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114924693 | Robert D. Russo | Radiology | 75 Kings Highway Cutoff, Suite 1a, Fairfield, CT 06824-5340 | 2005-06-30 |
| 1629506092 | Amanda Mckenzie | Physician Assistant | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2017-05-30 |
| 1821546607 | Danielle Marie Centone | Physician Assistant | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2016-09-21 |
| 1881958213 | Mona Hayat Marrash | Specialist/Technologist | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2012-06-29 |
| 1124346481 | Andrew Raymond Baxter | Surgery | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2010-05-12 |
| 1417191503 | Karen Lynn Brown | Physician Assistant | 75 Kings Highway Cutoff, Fairfield, CT 06824 | 2009-04-21 |
| 1134368475 | Caitlin F. Patry | Physical Therapist | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2009-02-10 |
| 1720232952 | Christine Mccarthy | Psychologist | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2008-11-14 |
| 1477705382 | Thomas Barton Toothaker | Psychiatry & Neurology | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2008-10-22 |
| 1699940551 | Nicholas Alfred Blondin | Psychiatry & Neurology | 75 Kings Highway Cutoff, Fairfield, CT 06824-5340 | 2008-04-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942819826 | Lauren J Cotton | Student in an Organized Health Care Education/Training Program | 1073 North Benson Road, Fairfield, CT 06824 | 2020-07-28 |
| 1831652064 | Seagull Counseling & Therapy LLC | Social Worker | 35 Nutmeg Lane, Fairfield, CT 06824 | 2019-04-14 |
| 1871018390 | Richard Matthew Carraway | Nurse Practitioner | 117 Carlynn Drive, Fairfield, CT 06824 | 2017-08-05 |
| 1811426695 | Fairfield County Health & Wellness Services II LLC | Psychiatry & Neurology | 325 Reef Road/suite 109, Fairfield, CT 06824 | 2017-06-06 |
| 1487198214 | Evamarie Koehler Elinskas | Speech-Language Pathologist | 50 Potters Lane, Fairfield, CT 06824 | 2016-12-13 |
| 1447794441 | Nicholas C Kopazna | Counselor | 433 Meadow St, Fairfield, CT 06824 | 2016-12-09 |
| 1245686997 | Tyler Wayne Vitzthum | Chiropractor | 1995 Post Rd., Fairfield, CT 06824 | 2016-05-12 |
| 1184087660 | Beth Segaloff | Social Worker | 191 Catherine Terrace, Fairfield, CT 06824 | 2016-04-01 |
| 1518342781 | April Vanbergen | Counselor | 1275 Post Rd., Suite A5, Fairfield, CT 06824 | 2015-07-29 |
| 1982089181 | Mary Cilio | Social Worker | 173 Samp Mortar Drive, Fairfield, CT 06824 | 2015-07-29 |
| Find all providers in zip 06824 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730688920 | Fairfield Neuropsychology LLC | Clinical Neuropsychologist | 60 Thorpe St Fl 2, Fairfield, CT 06824-5725 | 2018-02-02 |
| 1518925262 | Kimi Carson | Clinical Neuropsychologist | 75 Kings Highway Cutoff, 5th Floor, Fairfield, CT 06824-5340 | 2006-05-03 |
| 1316912421 | Thomas E. Sullivan | Clinical Neuropsychologist | 2810 Mack Rd, Fairfield, OH 45014-5130 | 2006-02-22 |
| 1619942638 | Linda Hartmann | Clinical Neuropsychologist | 2810 Mack Rd, Fairfield, OH 45014-5130 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548761224 | Shumita Roy | Clinical Neuropsychologist | 18 N Main St Fl 2, West Hartford, CT 06107-1970 | 2018-02-27 |
| 1992216790 | Brisman Associates In Neuropsychology, Pllc | Clinical Neuropsychologist | 433 S Main St Ste 225, West Hartford, CT 06110-2812 | 2017-10-19 |
| 1083157556 | Eva Troyb | Clinical Neuropsychologist | 26 Hawks Lndg, Amston, CT 06231-1659 | 2016-11-30 |
| 1669824702 | Martin D Oliveira Psy D LLC | Clinical Neuropsychologist | 10 N Main St Ste 1, West Hartford, CT 06107-1968 | 2016-07-12 |
| 1497151245 | Connecticut Neuropsychological Associates, LLC | Clinical Neuropsychologist | 40 Connecticut Ave, Norwich, CT 06360-1502 | 2014-11-06 |
| 1750795647 | James W. Pier, Ph.d., LLC | Clinical Neuropsychologist | 700 West Johnson Ave., Suite #310, Cheshire, CT 06410 | 2014-06-18 |
| 1922424175 | Psych Solutions LLC | Clinical Neuropsychologist | 2795 Albany Ave, West Hartford, CT 06117-1804 | 2014-03-12 |
| 1194157313 | Ginger Mills | Clinical Neuropsychologist | 623 Newfield Ave, Stamford, CT 06905-3302 | 2013-07-30 |
| 1144561051 | Western Connecticut Behavioral Health | Clinical Neuropsychologist | 828 Federal Rd, 2nd Floor, Brookfield, CT 06804-1830 | 2013-03-04 |
| 1043569288 | David Porrino | Clinical Neuropsychologist | 85 Old Kings Hwy N Fl 2, Darien, CT 06820-4732 | 2012-09-04 |
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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.