Healthcare Provider Details

I. General information

NPI: 1952536203
Provider Name (Legal Business Name): JENNIFER M STONE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 ADDAX CT
ROCKLIN CA
95765-6280
US

IV. Provider business mailing address

23986 ALISO CREEK RD # 1050
LAGUNA NIGUEL CA
92677-3908
US

V. Phone/Fax

Practice location:
  • Phone: 949-383-7718
  • Fax:
Mailing address:
  • Phone: 949-383-7718
  • Fax: 949-449-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: