| Doctor Name: | DR. MARY RUVEN STOCK |
| NPI Number: | 1811153042 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, LCSW |
| License Number: | C2936 |
| Business Practice Address: | 4423 Leisure Time Dr # C Diamondhead, MS - 395253221 |
| Business Phone Number: | 5046166097 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1144, KILN |
| State: | MS |
| Postal Code: | 395561144 |
| Phone Number: | 5046166097 |
| Fax Number: | |
| NPI Enumeration Date: | 08/07/2008 |
| NPI Last Update Date: | 08/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C2936 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |