Provider Demographics
NPI:1568564862
Name:STONEMAN, MARY BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:STONEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:35854 BUTCHART ST
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7634
Mailing Address - Country:US
Mailing Address - Phone:951-677-1926
Mailing Address - Fax:
Practice Address - Street 1:35854 BUTCHART ST.
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7634
Practice Address - Country:US
Practice Address - Phone:951-677-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS178021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS17802OtherCLINICAL SOCIAL WORK LICE