Provider Demographics
NPI:1477281665
Name:ABRAHAN, STELLA M (MFT, MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:M
Last Name:ABRAHAN
Suffix:
Gender:F
Credentials:MFT, MD
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:MARIS
Other - Last Name:ABRAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT,DAC,DIPLOMATE,MD
Mailing Address - Street 1:1005 E LAS TUNAS DR # 235
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1614
Mailing Address - Country:US
Mailing Address - Phone:626-491-3156
Mailing Address - Fax:
Practice Address - Street 1:2260 BRENTFORD RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108
Practice Address - Country:US
Practice Address - Phone:626-491-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015056103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty