Provider Demographics
NPI:1386707297
Name:BLUESTONE, MICHAEL A (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BLUESTONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 JAYSMITH STREET
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2404
Mailing Address - Country:US
Mailing Address - Phone:703-757-0791
Mailing Address - Fax:703-757-0791
Practice Address - Street 1:924 JAYSMITH STREET
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2404
Practice Address - Country:US
Practice Address - Phone:703-757-0791
Practice Address - Fax:703-757-0791
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0811000655103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist