Provider Demographics
NPI:1558690354
Name:PETERS, STEFANIE DOYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:DOYLE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 S SEPULVEDA BLVD
Mailing Address - Street 2:STE 1100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-7090
Mailing Address - Country:US
Mailing Address - Phone:310-204-6250
Mailing Address - Fax:310-204-6250
Practice Address - Street 1:3415 S SEPULVEDA BLVD
Practice Address - Street 2:STE 1100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-7090
Practice Address - Country:US
Practice Address - Phone:310-204-6250
Practice Address - Fax:310-204-6250
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical