MEDICARE: DR. ANN-MARIE STEPHENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 13812	CA

General Provider Information

NPI Number	:	1073511069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN-MARIE STEPHENSON

Provider Business Mailing Address
First Line	:	PO BOX 94477
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91109-4477
Country	:	US
Telephone Number	:	213-538-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 WILSHIRE BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4587
Country	:	US
Telephone Number	:	213-538-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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