Provider Demographics
NPI:1104106129
Name:STEPHEN SOLARI
Entity type:Organization
Organization Name:STEPHEN SOLARI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOLARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:209-403-9453
Mailing Address - Street 1:9230 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9409
Mailing Address - Country:US
Mailing Address - Phone:209-403-9453
Mailing Address - Fax:
Practice Address - Street 1:9230 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-9409
Practice Address - Country:US
Practice Address - Phone:209-403-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC13588320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness