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General NPI Number Information
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NPI Number | 1669771812
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Entity Type | Individual
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Provider Name | SHERMAN S STOVALL JR. LCSW-R, MA
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Gender | Male
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Dates
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Enumeration Date | 03/26/2011
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 6 CHELSEA PL
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City | CLIFTON PARK
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State | NY
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Zip | 12065-3216
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Country | US
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Telephone | 518-253-4229
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Fax | 518-565-0533
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Provider Business Mailing Address
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Address Line | 816 S BROADWAY
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City | MALTA
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State | NY
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Zip | 12020-5207
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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 |
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Name |
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Credential |
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Telephone |
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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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