Provider Demographics
NPI:1831621879
Name:BOND, STEFANIE JEAN (AMFT)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:JEAN
Last Name:BOND
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRESTA CIR APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1906
Mailing Address - Country:US
Mailing Address - Phone:415-755-0130
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2712
Practice Address - Country:US
Practice Address - Phone:415-454-9444
Practice Address - Fax:415-454-4864
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110271101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health