Provider Demographics
NPI:1518067131
Name:KITTRIDGE, STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:KITTRIDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42104 N VENTURE DR # D-106Z
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3823
Mailing Address - Country:US
Mailing Address - Phone:623-878-2100
Mailing Address - Fax:
Practice Address - Street 1:42104 N VENTURE DR STE D106
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3836
Practice Address - Country:US
Practice Address - Phone:623-878-2100
Practice Address - Fax:602-253-8891
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-2786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ73686Medicare ID - Type Unspecified
AZWCMBNMedicare UPIN