Healthcare Provider Details

I. General information

NPI: 1316313612
Provider Name (Legal Business Name): STEPHANIE URBANIEC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW66906
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW101626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: