Provider Demographics
NPI:1396080339
Name:LEGACY LCSW COUNSELING SERVICES PC
Entity type:Organization
Organization Name:LEGACY LCSW COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-364-6632
Mailing Address - Street 1:132 GARNETT LN
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9538
Mailing Address - Country:US
Mailing Address - Phone:518-364-6632
Mailing Address - Fax:518-565-0533
Practice Address - Street 1:1541 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6001
Practice Address - Country:US
Practice Address - Phone:518-364-6632
Practice Address - Fax:518-565-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0789681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty