Healthcare Provider Details

I. General information

NPI: 1225238660
Provider Name (Legal Business Name): CHARLES LADD STOLL LCSW,CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MEARNS AVE
HIGHLAND FALLS NY
10928-1009
US

IV. Provider business mailing address

123 MEARNS AVE
HIGHLAND FALLS NY
10928-1009
US

V. Phone/Fax

Practice location:
  • Phone: 718-781-4005
  • Fax: 845-977-0244
Mailing address:
  • Phone: 718-781-4005
  • Fax: 845-977-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076977
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: