Provider Demographics
NPI:1497250617
Name:BARBA, STEPHANNE NOEMMY
Entity Type:Individual
Prefix:
First Name:STEPHANNE
Middle Name:NOEMMY
Last Name:BARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 N NORTHSTAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6635
Mailing Address - Country:US
Mailing Address - Phone:909-213-5519
Mailing Address - Fax:
Practice Address - Street 1:9445 FAIRWAY VIEW PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0929
Practice Address - Country:US
Practice Address - Phone:909-983-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2022-08-25
Deactivation Date:2022-06-21
Deactivation Code:
Reactivation Date:2022-08-25
Provider Licenses
StateLicense IDTaxonomies
CA133183106H00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician