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NPI Code Detail

MEDICARE: BERTHOLD E STOVER LCSW

MEDICARE: BERTHOLD E STOVER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34007054AIN

General Provider Information

NPI Number : 1225469877
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERTHOLD E STOVER LCSW
Provider Business Mailing Address
First Line : 1716 HARTFORD ST.
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2138
Country : US
Telephone Number : 765-742-1567
Fax Number : 765-429-2700
Provider Business Practice Location Address
First Line : 1716 HARTFORD ST.
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2138
Country : US
Telephone Number : 765-742-1567
Fax Number : 765-429-2700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2013
Last Update Date : 02/09/2017

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Directions to “ BERTHOLD E STOVER LCSW” Practice Location

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