Healthcare Provider Details

I. General information

NPI: 1740595503
Provider Name (Legal Business Name): LORI A. STOCKTON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 CREEK RD
YOUNGSTOWN NY
14174-9609
US

IV. Provider business mailing address

4061 CREEK RD
YOUNGSTOWN NY
14174-9609
US

V. Phone/Fax

Practice location:
  • Phone: 716-754-8281
  • Fax: 716-286-7855
Mailing address:
  • Phone: 716-754-8281
  • Fax: 716-286-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR043271-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: