Provider Demographics
NPI:1356878417
Name:SEGAL, STEPHANIE (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SEGAL
Other - Last Name:KRETCHMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ACSW
Mailing Address - Street 1:12946 VALLEYHEART DR APT 116
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1978
Mailing Address - Country:US
Mailing Address - Phone:818-913-6464
Mailing Address - Fax:
Practice Address - Street 1:765 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1181
Practice Address - Country:US
Practice Address - Phone:213-580-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA730801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical