Provider Demographics
NPI:1558502211
Name:FERNANDEZ, STEPHANIE LISA (MFT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LISA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 HUGHES WAY #150
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810
Mailing Address - Country:US
Mailing Address - Phone:310-221-6350
Mailing Address - Fax:
Practice Address - Street 1:1501 HUGHES WAY #150
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810
Practice Address - Country:US
Practice Address - Phone:310-221-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7667OtherMEDICAL
CA7368OtherMEDICAL
CA7708OtherMEDICAL
CA7184OtherMEDICAL