Provider Demographics
NPI:1225238660
Name:STOLL, CHARLES LADD (LCSW,CASAC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LADD
Last Name:STOLL
Suffix:
Gender:M
Credentials:LCSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MEARNS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10928-1009
Mailing Address - Country:US
Mailing Address - Phone:718-781-4005
Mailing Address - Fax:845-977-0244
Practice Address - Street 1:123 MEARNS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND FALLS
Practice Address - State:NY
Practice Address - Zip Code:10928-1009
Practice Address - Country:US
Practice Address - Phone:718-781-4005
Practice Address - Fax:845-977-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0769771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03041967Medicaid
NYA300019025Medicare UPIN