Provider Demographics
NPI:1932742996
Name:LA MANTAIN, STEPHANEE VICTORIA
Entity Type:Individual
Prefix:
First Name:STEPHANEE
Middle Name:VICTORIA
Last Name:LA MANTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 N TOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3210
Mailing Address - Country:US
Mailing Address - Phone:909-631-5166
Mailing Address - Fax:
Practice Address - Street 1:1743 N TOWNE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3210
Practice Address - Country:US
Practice Address - Phone:909-631-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician