Provider Demographics
NPI:1114264611
Name:STUBBLEFIELD, SONDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SONDRA
Middle Name:
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5500
Mailing Address - Country:US
Mailing Address - Phone:805-499-6822
Mailing Address - Fax:
Practice Address - Street 1:867 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5500
Practice Address - Country:US
Practice Address - Phone:805-499-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 236531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical