Provider Demographics
NPI:1871019174
Name:FUGITA, STEPHANIE SHIGEKO (MFT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:SHIGEKO
Last Name:FUGITA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 HOLSTON RIVER CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2710
Mailing Address - Country:US
Mailing Address - Phone:408-375-0825
Mailing Address - Fax:
Practice Address - Street 1:2797 PARK AVE STE 206
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6064
Practice Address - Country:US
Practice Address - Phone:415-758-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT39282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist