Provider Demographics
NPI:1366027880
Name:STEPHANS-BROWN, MARY (NONE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STEPHANS-BROWN
Suffix:
Gender:F
Credentials:NONE
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Other - Credentials:
Mailing Address - Street 1:46 BARBADOS DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3312
Mailing Address - Country:US
Mailing Address - Phone:949-292-0884
Mailing Address - Fax:
Practice Address - Street 1:2670 N MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6693
Practice Address - Country:US
Practice Address - Phone:949-357-2556
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician