Provider Demographics
NPI:1972729465
Name:STONE, JENNIFER ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:STONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 SEA RIDGE RD
Mailing Address - Street 2:#D
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4362
Mailing Address - Country:US
Mailing Address - Phone:831-662-0505
Mailing Address - Fax:
Practice Address - Street 1:104 WALNUT AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3900
Practice Address - Country:US
Practice Address - Phone:831-423-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA067517OtherMANAGED HEALTH NETWORK PR
CAZZ300332OtherBLUE SHIELD PROVIDER NUMB
CA22695OtherMARRIAGE AND FAMILY THERA