Provider Demographics
NPI:1992534408
Name:PIMENTEL, STEPHANIE LEAH (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEAH
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 BAYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1305
Mailing Address - Country:US
Mailing Address - Phone:510-701-2930
Mailing Address - Fax:
Practice Address - Street 1:200 BUTCHER RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5616
Practice Address - Country:US
Practice Address - Phone:888-660-4243
Practice Address - Fax:833-233-2448
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW769631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical