Healthcare Provider Details

I. General information

NPI: 1417513482
Provider Name (Legal Business Name): STEPHANIE ATHENA CLAUDATOS PHD, DBSM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 BEAU RIVAGE
SAN PABLO CA
94806-4115
US

IV. Provider business mailing address

1506 2201 SHORE LINE DR #1506
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 650-485-1406
  • Fax:
Mailing address:
  • Phone: 408-515-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: