Healthcare Provider Details

I. General information

NPI: 1235152067
Provider Name (Legal Business Name): ALAN D. STILLMAN LCSW-R
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST
ONEIDA NY
13421-2111
US

IV. Provider business mailing address

4775 E LAKE RD
CAZENOVIA NY
13035-9347
US

V. Phone/Fax

Practice location:
  • Phone: 315-280-0400
  • Fax: 315-280-0087
Mailing address:
  • Phone: 315-655-9364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: