Provider Demographics
NPI:1104391671
Name:STONE, JESSE (LMSW, LSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:LMSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W 171ST ST APT 53A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1913
Mailing Address - Country:US
Mailing Address - Phone:414-737-3854
Mailing Address - Fax:
Practice Address - Street 1:63 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2378
Practice Address - Country:US
Practice Address - Phone:732-659-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103880-1104100000X
NJ44SL06398900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker