Provider Demographics
NPI:1255485751
Name:STONE, EDIE LAINE (ACSW)
Entity Type:Individual
Prefix:MS
First Name:EDIE
Middle Name:LAINE
Last Name:STONE
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 WEST MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-383-5200
Mailing Address - Fax:209-383-5700
Practice Address - Street 1:936 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-383-5200
Practice Address - Fax:209-383-5700
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00041301101YM0800X
OR4874-LCSW1041C0700X
CA369921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR600646725Medicaid
ORR162174OtherMEDICARE PTAN