Provider Demographics
NPI:1891141073
Name:HALL, STEPHANIE MONIQUE BRUSCHINI
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MONIQUE BRUSCHINI
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16580 HARBOR BLVD STE O
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1396
Mailing Address - Country:US
Mailing Address - Phone:714-604-3013
Mailing Address - Fax:
Practice Address - Street 1:16580 HARBOR BLVD STE O
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1396
Practice Address - Country:US
Practice Address - Phone:714-604-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist