Provider Demographics
NPI:1093869018
Name:HERRINGTON, STEPHANIE A (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:HERRINGTON
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:PO BOX 1378
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MECCA
Mailing Address - State:CA
Mailing Address - Zip Code:92254-1378
Mailing Address - Country:US
Mailing Address - Phone:760-396-1249
Mailing Address - Fax:760-396-1253
Practice Address - Street 1:801 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-325-4088
Practice Address - Fax:760-778-3781
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS219731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM00427MMedicare ID - Type Unspecified