Provider Demographics
NPI:1346353943
Name:STOKOLS, JEANNETTE J (PHD)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:J
Last Name:STOKOLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CORPORATE PARK
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606
Mailing Address - Country:US
Mailing Address - Phone:949-857-5182
Mailing Address - Fax:949-786-8295
Practice Address - Street 1:8 CORPORATE PARK
Practice Address - Street 2:SUITE 300
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606
Practice Address - Country:US
Practice Address - Phone:949-857-5182
Practice Address - Fax:949-786-8295
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4932103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP4932Medicare ID - Type Unspecified