Provider Demographics
NPI:1548383672
Name:STONE, SUSAN FOSTER (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FOSTER
Last Name:STONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23504 LYONS AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2500
Mailing Address - Country:US
Mailing Address - Phone:661-253-1719
Mailing Address - Fax:661-255-3751
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:661-253-1719
Practice Address - Fax:661-255-3751
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9940103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9940Medicare ID - Type UnspecifiedPROVIDER NUMBER