Provider Demographics
NPI:1497194328
Name:STEFANELLI, STEPHANIE LYNN (PSY D)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:STEFANELLI
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:4851 TORIDA WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3635
Mailing Address - Country:US
Mailing Address - Phone:951-252-4978
Mailing Address - Fax:
Practice Address - Street 1:2050 YOUTH WAY
Practice Address - Street 2:BLDG 1
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3819
Practice Address - Country:US
Practice Address - Phone:714-871-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27869103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist