Provider Demographics
NPI:1669775573
Name:STOLKNER, ED (LPE)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:STOLKNER
Suffix:
Gender:M
Credentials:LPE
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 38
Mailing Address - Street 2:
Mailing Address - City:BAR MILLS
Mailing Address - State:ME
Mailing Address - Zip Code:04004-0038
Mailing Address - Country:US
Mailing Address - Phone:207-929-3833
Mailing Address - Fax:
Practice Address - Street 1:MSAD 6 RTE 202
Practice Address - Street 2:
Practice Address - City:BAR MILLS
Practice Address - State:ME
Practice Address - Zip Code:04004-0038
Practice Address - Country:US
Practice Address - Phone:207-929-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPE731103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool