Healthcare Provider Details

I. General information

NPI: 1083985998
Provider Name (Legal Business Name): STEPHEN LAWRENCE MANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 OAKDALE RD
MODESTO CA
95355-3357
US

IV. Provider business mailing address

1225 OAKDALE RD
MODESTO CA
95355-3357
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-6200
  • Fax:
Mailing address:
  • Phone: 209-557-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number78482
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW78482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: