Provider Demographics
NPI:1811226954
Name:STONE, TARA MARIE (MA, LLP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:STONE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19517 CARDENE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-3198
Mailing Address - Country:US
Mailing Address - Phone:313-629-6244
Mailing Address - Fax:
Practice Address - Street 1:19517 CARDENE WAY
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-3198
Practice Address - Country:US
Practice Address - Phone:313-629-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist