Provider Demographics
NPI:1275890683
Name:STOFFREGEN, LILLIAN SHEA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:SHEA
Last Name:STOFFREGEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LYNOAK CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2909
Mailing Address - Country:US
Mailing Address - Phone:731-668-7593
Mailing Address - Fax:731-660-7512
Practice Address - Street 1:60 LYNOAK CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2909
Practice Address - Country:US
Practice Address - Phone:731-668-7593
Practice Address - Fax:731-660-7512
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000009321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker