Healthcare Provider Details

I. General information

NPI: 1659996007
Provider Name (Legal Business Name): STEPHANIE DEANE SINGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 MAGNOLIA AVE
LOS ANGELES CA
90007-1220
US

IV. Provider business mailing address

1910 MAGNOLIA AVE
LOS ANGELES CA
90007-1220
US

V. Phone/Fax

Practice location:
  • Phone: 213-342-0100
  • Fax: 213-342-0200
Mailing address:
  • Phone: 213-342-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number121522
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97493
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW121522
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW97493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: