Provider Demographics
NPI:1699037176
Name:EMDE, STEPHANIE PIM
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PIM
Last Name:EMDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:PIM
Other - Last Name:EMDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2743 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2538
Mailing Address - Country:US
Mailing Address - Phone:951-788-9515
Mailing Address - Fax:
Practice Address - Street 1:2743 ORANGE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2538
Practice Address - Country:US
Practice Address - Phone:951-788-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health