Provider Demographics
NPI:1801088315
Name:TARTARO-STOLP, CHRISTINA JOSET (LCSW CASAC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOSET
Last Name:TARTARO-STOLP
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1457
Mailing Address - Country:US
Mailing Address - Phone:315-449-1504
Mailing Address - Fax:
Practice Address - Street 1:405 REVERE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1457
Practice Address - Country:US
Practice Address - Phone:315-449-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0547931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical