Provider Demographics
NPI:1649046079
Name:WATKINS, STEPHANIE (MSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15486 DAYBREAK LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0976
Mailing Address - Country:US
Mailing Address - Phone:909-265-1480
Mailing Address - Fax:
Practice Address - Street 1:13530 SYLMAR DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3421
Practice Address - Country:US
Practice Address - Phone:909-265-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker