Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 5647 | OH |
NPI | 1023197787 |
---|---|
Provider Name | Dr. Ellen F. Stark |
First Address | Mansfield, OH 44903-9718 |
Second Address | Mansfield, OH 44903-9718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 21/09/2009 |