MEDICARE: DR. CYNTHIA H STONE PHD

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
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1659461549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA H STONE PHD

Provider Business Mailing Address
First Line	:	117 4TH ST
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091
Country	:	US
Telephone Number	:	847-256-2634
Fax Number	:	847-256-2634

Provider Business Practice Location Address
First Line	:	1609 SHERMAN AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3753
Country	:	US
Telephone Number	:	847-571-6351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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