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General NPI Number Information
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NPI Number | 1124250451
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Entity Type | Individual
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Provider Name | PETRA STONE LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 212 EAST AVE
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-2106
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Country | US
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Telephone | 607-765-1991
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 N BURDICK ST STE 201
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9463
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Country | US
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Telephone | 607-765-1991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R051594-1
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License Number State | NY
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