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General NPI Number Information
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NPI Number | 1265083968
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Entity Type | Individual
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Provider Name | JETT STONE PHD
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Gender | Male
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 150 E 58TH ST FL 21
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City | NEW YORK
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State | NY
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Zip | 10155-0002
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Country | US
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Telephone | 856-471-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 201 50TH AVE APT 12C
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-5773
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Country | US
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Telephone | 646-797-6703
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 023339
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License Number State | NY
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