Healthcare Provider Details

I. General information

NPI: 1003176249
Provider Name (Legal Business Name): STEFANIE FAJARDO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COMMONWEALTH AVE FL 6
LOS ANGELES CA
90005-4016
US

IV. Provider business mailing address

600 S COMMONWEALTH AVE FL 6
LOS ANGELES CA
90005-4016
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-7288
  • Fax: 310-533-2236
Mailing address:
  • Phone: 424-306-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: