Provider Demographics
NPI:1073600607
Name:STONE, CAROLYN R (EDD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:R
Last Name:STONE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-8 HARTFORD STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461
Mailing Address - Country:US
Mailing Address - Phone:617-630-1523
Mailing Address - Fax:617-630-1523
Practice Address - Street 1:30 LINCOLN ST
Practice Address - Street 2:STE 3
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1527
Practice Address - Country:US
Practice Address - Phone:617-630-1523
Practice Address - Fax:617-630-1523
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3145103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA729246OtherTUFT HEALTH PLAN
MA110325000OtherMAGELLAN BEHAVIORAL HEALT