Healthcare Provider Details

I. General information

NPI: 1104446533
Provider Name (Legal Business Name): LYNDSEY STILLMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

76 VETERANS AVE
BATH NY
14810-0810
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-5870
  • Fax: 607-644-4360
Mailing address:
  • Phone: 607-664-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: