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General NPI Number Information
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NPI Number | 1396080339
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Entity Type | Organization
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Legal Business Name | LEGACY LCSW COUNSELING SERVICES PC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 6 CHELSEA PL STE 103
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City | CLIFTON PARK
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State | NY
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Zip | 12065-3236
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Country | US
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Telephone | 844-253-4229
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Fax | 518-565-0533
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Provider Business Mailing Address
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Address Line | 10 HAMPSTEAD CT
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City | HALFMOON
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State | NY
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Zip | 12065-6249
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Country | US
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Telephone | 518-364-6632
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Fax | 518-565-0533
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Authorized Official
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Title or Position | OWNER
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Name | MR. SHERMAN S STOVALL JR.
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Credential | LCSW
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Telephone | 518-364-6632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 078968
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License Number State | NY
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