Provider Demographics
NPI:1598845471
Name:STONE, SAMARA NICOLE (LCSWC)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:NICOLE
Last Name:STONE
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 REISTERSTOWN RD # 1354
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3803
Mailing Address - Country:US
Mailing Address - Phone:410-296-2004
Mailing Address - Fax:
Practice Address - Street 1:320 E TOWSONTOWN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5331
Practice Address - Country:US
Practice Address - Phone:410-296-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002531300Medicaid
MD002531300Medicaid