Provider Demographics
NPI:1639402522
Name:STONE, REGENNA E (MA)
Entity Type:Individual
Prefix:
First Name:REGENNA
Middle Name:E
Last Name:STONE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MONTJOY STREET
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040
Mailing Address - Country:US
Mailing Address - Phone:859-654-6988
Mailing Address - Fax:
Practice Address - Street 1:318 MONTJOY STREET
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040
Practice Address - Country:US
Practice Address - Phone:859-654-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherGROUP AX ID NUMBER