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NPI Code Detail

MEDICARE: JESSE STONE LMSW, LSW

MEDICARE: JESSE STONE LMSW, LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker103880-1NY
2104100000XSocial Worker44SL06398900NJ

General Provider Information

NPI Number : 1104391671
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE STONE LMSW, LSW
Provider Business Mailing Address
First Line : 611 W 171ST ST APT 53A
Second Line :
City : NEW YORK
State : NY
Zip : 10032-1913
Country : US
Telephone Number : 414-737-3854
Fax Number :
Provider Business Practice Location Address
First Line : 63 MILLTOWN RD
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-2378
Country : US
Telephone Number : 732-659-0683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 10/10/2018

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