Provider Demographics
NPI:1497875462
Name:STONE, JUDITH NEMIROFF
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:NEMIROFF
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:NEMIROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:14 JASON CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6467
Mailing Address - Country:US
Mailing Address - Phone:781-641-0887
Mailing Address - Fax:781-641-1457
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6535
Practice Address - Country:US
Practice Address - Phone:781-641-1457
Practice Address - Fax:781-641-1457
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1071121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04655OtherBCBSMA PROVIDER NUMBER
MAP04655OtherBCBSMA PROVIDER NUMBER