Provider Demographics
NPI:1457846156
Name:STAMATIS, EVAGELIA A (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:EVAGELIA
Middle Name:A
Last Name:STAMATIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ASH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3856
Mailing Address - Country:US
Mailing Address - Phone:415-290-1491
Mailing Address - Fax:
Practice Address - Street 1:1975 HAMILTON AVE STE 37
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5630
Practice Address - Country:US
Practice Address - Phone:415-290-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist