Healthcare Provider Details

I. General information

NPI: 1700627247
Provider Name (Legal Business Name): CARMEN STONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 TWO TRAILS RD
SANTA FE NM
87505-9501
US

IV. Provider business mailing address

222 W MAPLE ST APT 2418
JEFFERSONVILLE IN
47130-3565
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-8829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARMEN STONE
Title or Position: OWNER
Credential:
Phone: 505-373-8829