Healthcare Provider Details

I. General information

NPI: 1992416929
Provider Name (Legal Business Name): BRENDA J. STONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
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:
Mailing address:
  • Phone: 614-832-3408
  • 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: BRENDA JOY STONE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LISW-S
Phone: 614-832-3408