Provider Demographics
NPI:1942424718
Name:STONE, JEROLD M (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEROLD
Middle Name:M
Last Name:STONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WALLACE AVE
Mailing Address - Street 2:SUITE 382
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6058
Mailing Address - Country:US
Mailing Address - Phone:941-366-0809
Mailing Address - Fax:941-922-9235
Practice Address - Street 1:100 WALLACE AVE
Practice Address - Street 2:SUITE 382
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6058
Practice Address - Country:US
Practice Address - Phone:941-366-0809
Practice Address - Fax:941-922-9235
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16781041C0700X
FLMT1190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2982Medicare UPIN
FLZ2156Medicare ID - Type Unspecified