Provider Demographics
NPI:1619164381
Name:STONEPHDLLC
Entity Type:Organization
Organization Name:STONEPHDLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-566-2810
Mailing Address - Street 1:3077 E 98TH ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2940
Mailing Address - Country:US
Mailing Address - Phone:317-566-2810
Mailing Address - Fax:317-566-2801
Practice Address - Street 1:3077 E 98TH ST
Practice Address - Street 2:SUITE 165
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2940
Practice Address - Country:US
Practice Address - Phone:317-566-2810
Practice Address - Fax:317-566-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040643251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN278380Medicare PIN