Healthcare Provider Details

I. General information

NPI: 1295253037
Provider Name (Legal Business Name): JOSEPHINE LAREE STOERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 WILLIAMS AVE
LA MESA CA
91942-7409
US

IV. Provider business mailing address

4387 46TH ST
SAN DIEGO CA
92115-4324
US

V. Phone/Fax

Practice location:
  • Phone: 619-668-4200
  • Fax: 619-698-1665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: