Provider Demographics
NPI:1306202825
Name:TOLENTINO, STEPHANIE ROCHELLE (CSWA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROCHELLE
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4931
Mailing Address - Country:US
Mailing Address - Phone:469-583-6668
Mailing Address - Fax:
Practice Address - Street 1:195 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3408
Practice Address - Country:US
Practice Address - Phone:541-762-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA41861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical