Provider Demographics
NPI:1811449101
Name:STINEMAN, CAROLYN (PHD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:STINEMAN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PAGE MILL RD APT 307
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2075
Mailing Address - Country:US
Mailing Address - Phone:785-764-5984
Mailing Address - Fax:
Practice Address - Street 1:425 PAGE MILL RD APT 307
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2075
Practice Address - Country:US
Practice Address - Phone:785-764-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19439103TB0200X
KS2567103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral