Healthcare Provider Details

I. General information

NPI: 1073600607
Provider Name (Legal Business Name): CAROLYN R STONE ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LINCOLN ST STE 3
NEWTON HIGHLANDS MA
02461-1527
US

IV. Provider business mailing address

4-8 HARTFORD STREET SUITE 204
NEWTON HIGHLANDS MA
02461
US

V. Phone/Fax

Practice location:
  • Phone: 617-630-1523
  • Fax: 617-630-1523
Mailing address:
  • Phone: 617-630-1523
  • Fax: 617-630-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3145
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3145
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: