Provider Demographics
NPI:1215019807
Name:STONE, ALICIA ANNE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANNE
Last Name:STONE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:ANNE
Other - Last Name:KOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:17939 CHATSWORTH ST
Mailing Address - Street 2:#275
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5606
Mailing Address - Country:US
Mailing Address - Phone:818-516-6584
Mailing Address - Fax:818-993-7249
Practice Address - Street 1:17939 CHATSWORTH ST
Practice Address - Street 2:#275
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5606
Practice Address - Country:US
Practice Address - Phone:818-516-6584
Practice Address - Fax:818-993-7249
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPSO13470OtherMEDI-CAL PROVIDER