Provider Demographics
NPI:1659051001
Name:FERMELIA, STEPHANIE ANNE REICH (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE REICH
Last Name:FERMELIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23941 LEEWARD DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4453
Mailing Address - Country:US
Mailing Address - Phone:714-679-5814
Mailing Address - Fax:
Practice Address - Street 1:27601 FORBES RD STE 49
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1242
Practice Address - Country:US
Practice Address - Phone:714-679-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS20544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health