Provider Demographics
NPI:1669664306
Name:BENJAMIN-STONE, ALICIA S
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:S
Last Name:BENJAMIN-STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8198 WESTMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2062
Mailing Address - Country:US
Mailing Address - Phone:863-858-1941
Mailing Address - Fax:863-858-1941
Practice Address - Street 1:8198 WESTMONT AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2062
Practice Address - Country:US
Practice Address - Phone:863-858-1941
Practice Address - Fax:863-858-1941
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906122261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care