Provider Demographics
NPI:1710109442
Name:AGASI, STEPHANIE ANN (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:AGASI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAZIE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3340
Mailing Address - Country:US
Mailing Address - Phone:925-689-6252
Mailing Address - Fax:
Practice Address - Street 1:2118 WILLOW PASS RD
Practice Address - Street 2:STE 500
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2408
Practice Address - Country:US
Practice Address - Phone:925-798-7500
Practice Address - Fax:925-798-7066
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF40138106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist