Individual
EDEN STONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 N CENTRAL AVE, KISSIMMEE, FL 34741-4450
(407) 925-5623
Mailing address
7 BLACK JACK CIR, PORT ORANGE, FL 32128-6751
(352) 332-8588
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S
—
FL
Enumeration date
02/22/2018
Last updated
12/02/2021
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