Provider Demographics
NPI:1114390440
Name:MANCINI, STEFANIE LAUREN (LMFT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LAUREN
Last Name:MANCINI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:LAUREN
Other - Last Name:KALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2090 EVANS LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2072
Mailing Address - Country:US
Mailing Address - Phone:408-793-2400
Mailing Address - Fax:
Practice Address - Street 1:2090 EVANS LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2072
Practice Address - Country:US
Practice Address - Phone:408-793-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist