Provider Demographics
NPI:1629276688
Name:STONE, AISHA R (IMF)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:R
Last Name:STONE
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BRODERICK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4498
Mailing Address - Country:US
Mailing Address - Phone:415-735-2700
Mailing Address - Fax:415-735-2701
Practice Address - Street 1:245 11TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3732
Practice Address - Country:US
Practice Address - Phone:415-355-0311
Practice Address - Fax:415-355-0353
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69889106H00000X
CA50315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942507835Medicaid
CA1720385032Medicaid