Provider Demographics
NPI:1982006797
Name:OTTERSTETTER, STEPHANIE APRIL
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:APRIL
Last Name:OTTERSTETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:APRIL
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 EDYTHE ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4019
Mailing Address - Country:US
Mailing Address - Phone:925-273-4106
Mailing Address - Fax:
Practice Address - Street 1:3095 INDEPENDENCE DR
Practice Address - Street 2:BLDG. B, STE. A
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7629
Practice Address - Country:US
Practice Address - Phone:925-443-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health