Provider Demographics
NPI:1235702374
Name:STELLA, EDWARD SCOTT
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:STELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:STELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12220 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6001
Mailing Address - Country:US
Mailing Address - Phone:818-612-0591
Mailing Address - Fax:
Practice Address - Street 1:12220 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-6001
Practice Address - Country:US
Practice Address - Phone:818-612-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32594103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist