Provider Demographics
NPI:1104015601
Name:STEVENS, STEFANIE A (AMFT 155468)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:F
Credentials:AMFT 155468
Other - Prefix:MS
Other - First Name:STEFANIE
Other - Middle Name:A
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTA155468
Mailing Address - Street 1:17 EMBARCADERO CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5214
Mailing Address - Country:US
Mailing Address - Phone:510-535-1344
Mailing Address - Fax:
Practice Address - Street 1:17 EMBARCADERO CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5214
Practice Address - Country:US
Practice Address - Phone:510-545-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155468106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist