Healthcare Provider Details

I. General information

NPI: 1801084397
Provider Name (Legal Business Name): STEPHANIE GAE DELANGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 E PACIFIC COAST HWY
LONG BEACH CA
90806-5017
US

IV. Provider business mailing address

PO BOX 641
LONG BEACH CA
90801-0641
US

V. Phone/Fax

Practice location:
  • Phone: 213-952-4284
  • Fax: 562-218-4076
Mailing address:
  • Phone: 562-599-9271
  • Fax: 562-218-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 16279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: