Provider Demographics
NPI:1982091914
Name:CAGAMPAN, STEFANIE (LMFT#85906)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:CAGAMPAN
Suffix:
Gender:F
Credentials:LMFT#85906
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 S SEPULVEDA BLVD APT 252
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6844
Mailing Address - Country:US
Mailing Address - Phone:310-945-7539
Mailing Address - Fax:
Practice Address - Street 1:3630 S SEPULVEDA BLVD APT 252
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6844
Practice Address - Country:US
Practice Address - Phone:310-945-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist