Healthcare Provider Details

I. General information

NPI: 1457556219
Provider Name (Legal Business Name): ELIZABETH STONE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 BATH RD
BRUNSWICK ME
04011-2609
US

IV. Provider business mailing address

115 HARBOR PL
SOUTH PORTLAND ME
04106-2861
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS1060
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: