Provider Demographics
NPI:1073950242
Name:CLIFFORD, STEPHAN LT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:LT
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 ASPINWALL DR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3902
Mailing Address - Country:US
Mailing Address - Phone:510-367-6219
Mailing Address - Fax:707-439-7844
Practice Address - Street 1:449 ASPINWALL DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3902
Practice Address - Country:US
Practice Address - Phone:510-367-6219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91697101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health