Provider Demographics
NPI:1184851974
Name:CHIN MAMMEN, STEPHANIE ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:CHIN MAMMEN
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 1:2400 E KATELLA AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5945
Mailing Address - Country:US
Mailing Address - Phone:657-224-9681
Mailing Address - Fax:
Practice Address - Street 1:2400 E KATELLA AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5945
Practice Address - Country:US
Practice Address - Phone:657-224-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA26085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program