Provider Demographics
NPI:1740574110
Name:STEPHEN, AMY L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:STEPHEN
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 1:2220 CAMINO DE LA REINA
Mailing Address - Street 2:UNIT 114
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5527
Mailing Address - Country:US
Mailing Address - Phone:619-806-6238
Mailing Address - Fax:
Practice Address - Street 1:2305 MEADE AVE # 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4113
Practice Address - Country:US
Practice Address - Phone:619-806-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS211551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical