Healthcare Provider Details

I. General information

NPI: 1932427473
Provider Name (Legal Business Name): STEPHANIE ROSE YOUNG PSY.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 16TH ST STE 309
SANTA MONICA CA
90404-1239
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4377
  • Fax: 310-319-4425
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number27735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: