Provider Demographics
NPI:1952536203
Name:STONE, JENNIFER M (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
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 1:6031 SAN YUBA WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-2852
Mailing Address - Country:US
Mailing Address - Phone:949-383-7718
Mailing Address - Fax:949-449-8892
Practice Address - Street 1:3950 LONG BEACH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5411
Practice Address - Country:US
Practice Address - Phone:949-383-7718
Practice Address - Fax:949-449-8892
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312294Medicaid