Provider Demographics
NPI:1801084397
Name:DELANGE, STEPHANIE GAE (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:GAE
Last Name:DELANGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-0641
Mailing Address - Country:US
Mailing Address - Phone:562-599-9271
Mailing Address - Fax:562-218-4076
Practice Address - Street 1:1028 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5017
Practice Address - Country:US
Practice Address - Phone:213-952-4284
Practice Address - Fax:562-218-4076
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 162791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical