Provider Demographics
NPI:1396042669
Name:STOLLER, SUSAN KLEINFELD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KLEINFELD
Last Name:STOLLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5434
Mailing Address - Country:US
Mailing Address - Phone:845-462-6798
Mailing Address - Fax:
Practice Address - Street 1:167 MYERS CORNERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3869
Practice Address - Country:US
Practice Address - Phone:845-298-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730354651041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool