Provider Demographics
NPI:1003176249
Name:FAJARDO, STEFANIE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:FAJARDO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S COMMONWEALTH AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4016
Mailing Address - Country:US
Mailing Address - Phone:424-306-7288
Mailing Address - Fax:
Practice Address - Street 1:600 S COMMONWEALTH AVE FL 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4016
Practice Address - Country:US
Practice Address - Phone:424-306-7288
Practice Address - Fax:310-533-2236
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical