Provider Demographics
NPI:1619067329
Name:LAW, STEPHANIE (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:STEPHANIE LAW
Other - Middle Name:PSYCHOLOGICAL
Other - Last Name:INC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 S OAKLAND AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2043
Mailing Address - Country:US
Mailing Address - Phone:626-354-5559
Mailing Address - Fax:
Practice Address - Street 1:16 S OAKLAND AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2043
Practice Address - Country:US
Practice Address - Phone:626-354-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22190103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-5458466OtherCALIFORNIA CORPORATION TAX ID