Provider Demographics
NPI:1992816946
Name:STONE, ROSALEEN MOZENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSALEEN
Middle Name:MOZENA
Last Name:STONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 NE EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4627
Mailing Address - Country:US
Mailing Address - Phone:503-434-9461
Mailing Address - Fax:503-434-9461
Practice Address - Street 1:315 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4627
Practice Address - Country:US
Practice Address - Phone:503-434-9461
Practice Address - Fax:503-434-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R0000TCNBFMedicare ID - Type Unspecified