Healthcare Provider Details

I. General information

NPI: 1154790749
Provider Name (Legal Business Name): SANDRA ROCIO STOLFI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 BRICKWAY BLVD
SANTA ROSA CA
95403-8226
US

IV. Provider business mailing address

110 SHAHAN DR
CLOVERDALE CA
95425-3017
US

V. Phone/Fax

Practice location:
  • Phone: 707-569-2300
  • Fax:
Mailing address:
  • Phone: 707-894-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberASW65492
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW65492
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: