Healthcare Provider Details

I. General information

NPI: 1699246876
Provider Name (Legal Business Name): STEPHANIE CLANCY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

IV. Provider business mailing address

16084 PETERSON CT
CHINO HILLS CA
91709-7913
US

V. Phone/Fax

Practice location:
  • Phone: 626-701-4249
  • Fax: 626-737-6034
Mailing address:
  • Phone: 714-356-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: