Provider Demographics
NPI:1619067329
Name:LAW, STEPHANIE (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:16 S OAKLAND AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2042
Mailing Address - Country:US
Mailing Address - Phone:626-354-5559
Mailing Address - Fax:
Practice Address - Street 1:16 S OAKLAND AVE STE 208
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2042
Practice Address - Country:US
Practice Address - Phone:626-354-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22190103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-5458466OtherCALIFORNIA CORPORATION TAX ID