Provider Demographics
NPI:1598492613
Name:MATTERN, STEPHANIE (ASW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MATTERN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 CORDELL CT STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-0915
Mailing Address - Country:US
Mailing Address - Phone:619-755-9961
Mailing Address - Fax:
Practice Address - Street 1:1870 CORDELL CT STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-0915
Practice Address - Country:US
Practice Address - Phone:619-755-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA105598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health