Provider Demographics
NPI:1265202907
Name:SHECTER STONE, ISABEL JAEKA I (ATR-BC, LCAT)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:JAEKA
Last Name:SHECTER STONE
Suffix:I
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 31ST ST APT 9L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0148
Mailing Address - Country:US
Mailing Address - Phone:917-584-9117
Mailing Address - Fax:
Practice Address - Street 1:155 E 31ST ST APT 9L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0148
Practice Address - Country:US
Practice Address - Phone:917-584-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002844221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11223399Medicaid