Healthcare Provider Details

I. General information

NPI: 1043420573
Provider Name (Legal Business Name): ANDREA BIXSON STONE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 F ST SUITE 5
DAVIS CA
95616-4150
US

IV. Provider business mailing address

429 F ST SUITE 5
DAVIS CA
95616-4150
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-8878
  • Fax:
Mailing address:
  • Phone: 530-753-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS15614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: