Basic Information
Provider Information
NPI: 1467613059
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STONE
FirstName: DAVID
MiddleName: C
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4332 24TH ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941143520
CountryCode: US
TelephoneNumber: 4159243391
FaxNumber: 4156437377
Practice Location
Address1: 3200 ADELINE ST
Address2:  
City: BERKELEY
State: CA
PostalCode: 947032407
CountryCode: US
TelephoneNumber: 5106010203
FaxNumber: 5106014002
Other Information
ProviderEnumerationDate: 06/17/2008
LastUpdateDate: 06/17/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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