Provider Demographics
NPI:1083382170
Name:JONES, MARTHA STORY
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:STORY
Last Name:JONES
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 1:495 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:CT
Mailing Address - Zip Code:06234-1607
Mailing Address - Country:US
Mailing Address - Phone:203-293-3718
Mailing Address - Fax:
Practice Address - Street 1:495 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1607
Practice Address - Country:US
Practice Address - Phone:203-293-3718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health