Healthcare Provider Details

I. General information

NPI: 1144356775
Provider Name (Legal Business Name): BRENDA JOY STONE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10617 STONEHAM DR
POWELL OH
43065-7454
US

IV. Provider business mailing address

10617 STONEHAM DR
POWELL OH
43065-7454
US

V. Phone/Fax

Practice location:
  • Phone: 614-832-3408
  • Fax: 614-875-4121
Mailing address:
  • Phone: 614-832-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI4504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: