=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679625503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LARRY STONE LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 W 125TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-4426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-932-6688
-----------------------------------------------------
Fax | 212-316-1479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 PEAR ST
-----------------------------------------------------
City | CENTRAL ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11722-4318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-582-6657
-----------------------------------------------------
Fax | 631-340-4041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 73-042792
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------