Provider Demographics
NPI:1689797540
Name:STONE, ANDREA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:STONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2457
Mailing Address - Country:US
Mailing Address - Phone:219-921-0705
Mailing Address - Fax:219-921-0557
Practice Address - Street 1:215 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2457
Practice Address - Country:US
Practice Address - Phone:219-921-0705
Practice Address - Fax:219-921-0557
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical