Provider Demographics
NPI:1669771812
Name:STOVALL, SHERMAN S JR (LCSW-R, MA)
Entity type:Individual
Prefix:MR
First Name:SHERMAN
Middle Name:S
Last Name:STOVALL
Suffix:JR
Gender:M
Credentials:LCSW-R, MA
Other - Prefix:
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Mailing Address - Street 1:816 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-5207
Mailing Address - Country:US
Mailing Address - Phone:518-364-6632
Mailing Address - Fax:518-565-0533
Practice Address - Street 1:6 CHELSEA PL
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3216
Practice Address - Country:US
Practice Address - Phone:518-253-4229
Practice Address - Fax:518-565-0533
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2020-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0789681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical