Provider Demographics
NPI:1528009867
Name:STONER, MARIE ELIZABETH (MED)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:STONER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E STATE ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-891-2773
Mailing Address - Fax:
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-891-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS00307-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000082915OtherHIGHMARK BLUE SHIELD