Provider Demographics
NPI:1730638131
Name:STEFANO, AQUA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AQUA
Middle Name:
Last Name:STEFANO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 WESTWOOD PLZ STE B650A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8358
Mailing Address - Country:US
Mailing Address - Phone:310-267-9711
Mailing Address - Fax:310-825-9596
Practice Address - Street 1:757 WESTWOOD PLZ STE B650A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2050
Practice Address - Country:US
Practice Address - Phone:310-267-9711
Practice Address - Fax:310-825-9596
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1125001041C0700X
OK201051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program