MEDICARE: ANITA ANNE STOLL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	24501	TX

General Provider Information

NPI Number	:	1487193694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA ANNE STOLL LCSW

Provider Business Mailing Address
First Line	:	1221 W BEN WHITE BLVD STE 108A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7183
Country	:	US
Telephone Number	:	512-789-3548
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W BEN WHITE BLVD STE 108A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-7183
Country	:	US
Telephone Number	:	512-789-3548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	02/21/2017

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