Provider Demographics
NPI:1811314610
Name:STONE, MARY DEY (CSA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DEY
Last Name:STONE
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 BOUSH ST
Mailing Address - Street 2:UNIT 107
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1358
Mailing Address - Country:US
Mailing Address - Phone:757-681-4467
Mailing Address - Fax:
Practice Address - Street 1:388 BOUSH ST
Practice Address - Street 2:UNIT 107
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1358
Practice Address - Country:US
Practice Address - Phone:757-681-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor