Provider Demographics
NPI:1063721462
Name:BROWN, STEFANIE M (MA, LMFT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24338 EL TORO RD # E-405
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2776
Mailing Address - Country:US
Mailing Address - Phone:949-636-1288
Mailing Address - Fax:
Practice Address - Street 1:24338 EL TORO RD # E-405
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2776
Practice Address - Country:US
Practice Address - Phone:949-636-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-02
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT-1024106H00000X, 106H00000X
CALMFT130597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist