Provider Demographics
NPI:1033348230
Name:TWEEDLY, STEFANIE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:M
Last Name:TWEEDLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 DOVE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2852
Mailing Address - Country:US
Mailing Address - Phone:949-706-4889
Mailing Address - Fax:949-258-7799
Practice Address - Street 1:1151 DOVE ST STE 130
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2852
Practice Address - Country:US
Practice Address - Phone:949-706-4889
Practice Address - Fax:949-258-7799
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27679103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical