Provider Demographics
NPI:1982438347
Name:MAGER-STONE, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MAGER-STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5654 W 625 S
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47874-7126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5654 W 625 S
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:IN
Practice Address - Zip Code:47874-7126
Practice Address - Country:US
Practice Address - Phone:812-251-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1439277103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool