Provider Demographics
NPI:1073737938
Name:STONE, DANIEL KENNETH (CAS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENNETH
Last Name:STONE
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 KEMPER ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4906
Mailing Address - Country:US
Mailing Address - Phone:619-758-1433
Mailing Address - Fax:619-758-9823
Practice Address - Street 1:3340 KEMPER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4906
Practice Address - Country:US
Practice Address - Phone:619-758-1433
Practice Address - Fax:619-758-9823
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8544Medicaid