Provider Demographics
NPI:1942340724
Name:STOLBACH, JILL A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:STOLBACH
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 1:201 EAST 83RD STREET
Mailing Address - Street 2:18F
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-794-0049
Mailing Address - Fax:
Practice Address - Street 1:952 5TH AVE
Practice Address - Street 2:SUITE 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1740
Practice Address - Country:US
Practice Address - Phone:212-794-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0338111104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N57072Medicare ID - Type Unspecified