MEDICARE: MS. CHANTAL MARIE STENDARDO LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	LCS 28677	CA

General Provider Information

NPI Number	:	1134300320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANTAL MARIE STENDARDO LCSW

Provider Business Mailing Address
First Line	:	1705 STONUM RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95351-4543
Country	:	US
Telephone Number	:	209-602-1475
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E 15TH ST
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95341-6217
Country	:	US
Telephone Number	:	209-381-6879
Fax Number	:

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

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	04/01/2022

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