Provider Demographics
NPI:1376533232
Name:OPENSHAW, STEPHEN KENNY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KENNY
Last Name:OPENSHAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E WILSHIRE AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1900
Mailing Address - Country:US
Mailing Address - Phone:714-526-1370
Mailing Address - Fax:
Practice Address - Street 1:110 E WILSHIRE AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1900
Practice Address - Country:US
Practice Address - Phone:714-526-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR62385Medicare UPIN