Provider Demographics
NPI:1376341347
Name:MADRIGAL, STEPHANIE MARIE (SUDRC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDRC
Mailing Address - Street 1:13386 MARENGO RD
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8429
Mailing Address - Country:US
Mailing Address - Phone:209-566-6715
Mailing Address - Fax:
Practice Address - Street 1:13386 MARENGO RD
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8429
Practice Address - Country:US
Practice Address - Phone:925-974-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)