Provider Demographics
NPI:1639248743
Name:STONE, KENNETH (EDD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:STONE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3529
Mailing Address - Country:US
Mailing Address - Phone:508-823-0304
Mailing Address - Fax:508-880-9887
Practice Address - Street 1:125 HIGH ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3529
Practice Address - Country:US
Practice Address - Phone:508-823-0304
Practice Address - Fax:508-880-9887
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0512397Medicaid
MA0512397Medicaid