Provider Demographics
NPI:1114213741
Name:STONE, PETER (MLADC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:MLADC
Other - Prefix:MR
Other - First Name:D
Other - Middle Name:PETER
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE GREEN RD
Mailing Address - Street 2:B-5
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-5209
Mailing Address - Country:US
Mailing Address - Phone:603-702-0117
Mailing Address - Fax:603-509-2405
Practice Address - Street 1:2 VILLAGE GREEN RD
Practice Address - Street 2:B-5
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-5209
Practice Address - Country:US
Practice Address - Phone:603-702-0117
Practice Address - Fax:603-509-2405
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0840101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
12255767OtherCAQH