Provider Demographics
NPI:1568526986
Name:RATH, STEPHANIE JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:RATH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22757 SKYRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PRATHER
Mailing Address - State:CA
Mailing Address - Zip Code:93651-9783
Mailing Address - Country:US
Mailing Address - Phone:559-323-5479
Mailing Address - Fax:
Practice Address - Street 1:4785 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0513
Practice Address - Country:US
Practice Address - Phone:559-448-4192
Practice Address - Fax:559-448-4867
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20782OtherLCSW