Provider Demographics
NPI:1639396302
Name:KATZ, STEPHANIE ELLIS (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELLIS
Last Name:KATZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELLIS
Other - Last Name:SHEARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7555 VAN NUYS BLVD
Mailing Address - Street 2:CUBICLE #4N047
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-1949
Mailing Address - Country:US
Mailing Address - Phone:818-904-8807
Mailing Address - Fax:
Practice Address - Street 1:7555 VAN NUYS BLVD
Practice Address - Street 2:CUBICLE #4N047
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-904-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical