Provider Demographics
NPI:1629113931
Name:STOLL, RONDA LYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:LYNN
Last Name:STOLL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601
Mailing Address - Country:US
Mailing Address - Phone:802-229-1950
Mailing Address - Fax:802-888-6659
Practice Address - Street 1:1001 PAINE TURNPIKE N
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-229-1950
Practice Address - Fax:802-888-6659
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900004141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010914Medicaid
VT19146OtherBLUE CROSS BLUE SHIELD