Healthcare Provider Details

I. General information

NPI: 1245535806
Provider Name (Legal Business Name): STEPHANIE SALCEDO ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 IMPERIAL HWY STE C103
SANTA FE SPRINGS CA
90670-6735
US

IV. Provider business mailing address

1721 GRIFFIN AVE
LOS ANGELES CA
90031-3312
US

V. Phone/Fax

Practice location:
  • Phone: 323-592-4684
  • Fax:
Mailing address:
  • Phone: 323-221-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number95-2633765
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number106134
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106134
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: