Provider Demographics
NPI:1477808624
Name:STOLBERG, AMY NOREEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:NOREEN
Last Name:STOLBERG
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 1:919 WINTON RD S STE 211
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1637
Mailing Address - Country:US
Mailing Address - Phone:585-739-6968
Mailing Address - Fax:
Practice Address - Street 1:919 WINTON RD S STE 211
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1637
Practice Address - Country:US
Practice Address - Phone:857-396-9685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03586725Medicaid