Provider Demographics
NPI:1710623632
Name:STONE, SUSAN C (MFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:STONE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 COLDWATER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1732
Mailing Address - Country:US
Mailing Address - Phone:310-276-7329
Mailing Address - Fax:
Practice Address - Street 1:2073 COLDWATER CANYON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1732
Practice Address - Country:US
Practice Address - Phone:310-276-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954810785OtherANTHEM