Healthcare Provider Details

I. General information

NPI: 1457912180
Provider Name (Legal Business Name): ROBERTA L STOCKTON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1127 W MAIN ST
ZANESVILLE OH
43701-3147
US

IV. Provider business mailing address

1127 W MAIN ST
ZANESVILLE OH
43701-3147
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-1266
  • Fax: 740-454-7650
Mailing address:
  • Phone: 740-454-1266
  • Fax: 740-454-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberS.1600863
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: