Provider Demographics
NPI:1467787135
Name:ROSCOE, STEFANI (LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W SLAUSON AVE
Mailing Address - Street 2:SUITE 178
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6582
Mailing Address - Country:US
Mailing Address - Phone:213-255-5629
Mailing Address - Fax:
Practice Address - Street 1:5601 W SLAUSON AVE
Practice Address - Street 2:SUITE 178
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6582
Practice Address - Country:US
Practice Address - Phone:213-255-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL