Healthcare Provider Details

I. General information

NPI: 1467710905
Provider Name (Legal Business Name): JESSICA EVE STOLLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVE STOLLER LCSW

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 EL CAMINO REAL STE 13A-250
PALO ALTO CA
94301-2305
US

IV. Provider business mailing address

855 EL CAMINO REAL STE 13A-250
PALO ALTO CA
94301-2305
US

V. Phone/Fax

Practice location:
  • Phone: 650-922-3979
  • Fax:
Mailing address:
  • Phone: 650-922-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: