Provider Demographics
NPI:1669796017
Name:SENTIWANY STONE, TERRA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:
Last Name:SENTIWANY STONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4002
Mailing Address - Country:US
Mailing Address - Phone:518-783-5381
Mailing Address - Fax:518-783-0125
Practice Address - Street 1:636 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4002
Practice Address - Country:US
Practice Address - Phone:518-783-5381
Practice Address - Fax:518-783-0125
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0750121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical