Provider Demographics
NPI:1104181478
Name:STEPHANOPOULOS, ANDREW ROBERT (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ROBERT
Last Name:STEPHANOPOULOS
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:216
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:310-422-4248
Mailing Address - Fax:
Practice Address - Street 1:9911 W PICO BLVD
Practice Address - Street 2:SUITE 1480
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2703
Practice Address - Country:US
Practice Address - Phone:310-422-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT#48634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist