MEDICARE: BRITTON MARIE STOCKDALE LMSW

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
1	104100000X	Social Worker	12110	TN

General Provider Information

NPI Number	:	1326973421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTON MARIE STOCKDALE LMSW

Provider Business Mailing Address
First Line	:	77 STONEBRIDGE BLVD STE B
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2165
Country	:	US
Telephone Number	:	731-207-0560
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 STONEBRIDGE BLVD STE B
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2165
Country	:	US
Telephone Number	:	731-207-0560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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