Provider Demographics
NPI:1821877796
Name:STONE, SALLY ALEXANDRA
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ALEXANDRA
Last Name: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 1:178 COLUMBUS AVE UNIT 230636
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-9624
Mailing Address - Country:US
Mailing Address - Phone:929-274-0996
Mailing Address - Fax:
Practice Address - Street 1:2501 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4640
Practice Address - Country:US
Practice Address - Phone:929-274-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health