Provider Demographics
NPI:1720127293
Name:LUCCHESI, STEPHANIE ROTH (MS COUNSELING, MFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROTH
Last Name:LUCCHESI
Suffix:
Gender:F
Credentials:MS COUNSELING, MFT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LOUISE
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS COUNSELING, MFT
Mailing Address - Street 1:4232 BROOKHILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6923
Mailing Address - Country:US
Mailing Address - Phone:916-207-1067
Mailing Address - Fax:916-967-7304
Practice Address - Street 1:3125 DWIGHT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-691-2200
Practice Address - Fax:916-967-7304
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
CAMFC 30942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist