Healthcare Provider Details

I. General information

NPI: 1275268906
Provider Name (Legal Business Name): STEPHANIE STIAVETTI MA, AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 10/01/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 FAIR OAKS BLVD UNIT 2216
CARMICHAEL CA
95609-3587
US

IV. Provider business mailing address

6929 FAIR OAKS BLVD UNIT 2216
CARMICHAEL CA
95609-3587
US

V. Phone/Fax

Practice location:
  • Phone: 916-675-3954
  • Fax: 916-581-8698
Mailing address:
  • Phone: 916-675-3954
  • Fax: 916-581-8698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC14150
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT140123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: