Provider Demographics
NPI:1033310818
Name:STAFFORD, SHARON LEE (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E YORBA LINDA BLVD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3006
Mailing Address - Country:US
Mailing Address - Phone:714-309-4633
Mailing Address - Fax:714-961-8916
Practice Address - Street 1:601 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE ONE
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3006
Practice Address - Country:US
Practice Address - Phone:714-309-4633
Practice Address - Fax:714-961-8916
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical