Provider Demographics
NPI:1790934552
Name:STANFORD, DENNYSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNYSE
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LAKE BELLEVUE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2479
Mailing Address - Country:US
Mailing Address - Phone:425-223-0702
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2479
Practice Address - Country:US
Practice Address - Phone:425-223-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003813103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPL193860Medicare PIN