Provider Demographics
NPI:1972729069
Name:STONE, JEFFREY A (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:STONE
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 1:3300 DOUGLAS BLVD.
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-787-0555
Mailing Address - Fax:916-787-6222
Practice Address - Street 1:3300 DOUGLAS BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3844
Practice Address - Country:US
Practice Address - Phone:916-787-0555
Practice Address - Fax:916-787-6222
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11877103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling