Healthcare Provider Details

I. General information

NPI: 1861774234
Provider Name (Legal Business Name): STEPHANIE R VILLASENOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 RALL AVE
CLOVIS CA
93619-6938
US

IV. Provider business mailing address

4290 RALL AVE
CLOVIS CA
93619-6938
US

V. Phone/Fax

Practice location:
  • Phone: 559-259-2350
  • Fax:
Mailing address:
  • Phone: 559-259-2350
  • Fax: 559-259-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: