Provider Demographics
NPI:1881031300
Name:DELGADO-WILLIS, STACY NICOLE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:NICOLE
Last Name:DELGADO-WILLIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 INGLEWOOD AVE STE 660
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1121
Mailing Address - Country:US
Mailing Address - Phone:424-442-0779
Mailing Address - Fax:
Practice Address - Street 1:851 PINE AVE STE 103
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:424-442-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF71629106H00000X
CALMFT103350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist