Provider Demographics
NPI:1609197847
Name:STONE, GALEN LUTHER (LICSW)
Entity Type:Individual
Prefix:
First Name:GALEN
Middle Name:LUTHER
Last Name:STONE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2424
Mailing Address - Country:US
Mailing Address - Phone:781-986-4800
Mailing Address - Fax:781-986-4801
Practice Address - Street 1:9 CANTON ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2424
Practice Address - Country:US
Practice Address - Phone:781-986-4800
Practice Address - Fax:781-986-4801
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1215051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical