| Doctor Name: | CAROL STACK |
| NPI Number: | 1164526703 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 101-00112255 |
| Business Practice Address: | Anna Marsh Lane Brattleboro, VT - 05302 |
| Business Phone Number: | 8022577785 |
| Business Fax Number: | |
| Mailing Address: | Anna Marsh Lane, BRATTLEBORO |
| State: | VT |
| Postal Code: | 05302 |
| Phone Number: | 8022577785 |
| Fax Number: | |
| NPI Enumeration Date: | 09/12/2006 |
| NPI Last Update Date: | 09/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0808X |
| License Number: | 101-00112255 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |