Provider Demographics
NPI:1184464463
Name:STOLL, AMANDA LEE (MSW, RCSWI)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:STOLL
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 BAHIA VISTA ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2625
Mailing Address - Country:US
Mailing Address - Phone:941-202-1999
Mailing Address - Fax:941-202-2009
Practice Address - Street 1:2650 BAHIA VISTA ST STE 204
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2625
Practice Address - Country:US
Practice Address - Phone:941-202-1999
Practice Address - Fax:941-202-2009
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW20388104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker