Provider Demographics
NPI:1336402635
Name:EKROSS, STEPHANIE BERNARDEZ (LCSW)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:BERNARDEZ
Last Name:EKROSS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 LISMORE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2655
Mailing Address - Country:US
Mailing Address - Phone:747-641-1955
Mailing Address - Fax:
Practice Address - Street 1:9065 LISMORE DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2655
Practice Address - Country:US
Practice Address - Phone:747-641-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA890281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical