Provider Demographics
NPI:1922513191
Name:BRACAMONTE, STEPHANIE BERNICE (MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BERNICE
Last Name:BRACAMONTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 FIR TREE WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2609
Mailing Address - Country:US
Mailing Address - Phone:559-430-9080
Mailing Address - Fax:
Practice Address - Street 1:1329 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4753
Practice Address - Country:US
Practice Address - Phone:559-430-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT39247106H00000X
WA61150254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist