Provider Demographics
NPI:1215641543
Name:MCGURK, STEPHANIE SHIELDS
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:SHIELDS
Last Name:MCGURK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N WEST KNOLL DR APT B
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5200
Mailing Address - Country:US
Mailing Address - Phone:310-994-4387
Mailing Address - Fax:
Practice Address - Street 1:2306 W 73RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5342
Practice Address - Country:US
Practice Address - Phone:310-994-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker