Healthcare Provider Details

I. General information

NPI: 1396183067
Provider Name (Legal Business Name): STEPHANIE WRIGHT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 07/21/2022
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15409 DICKENS ST
SHERMAN OAKS CA
91403-3009
US

IV. Provider business mailing address

15409 DICKENS ST
SHERMAN OAKS CA
91403-3009
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-4362
  • Fax:
Mailing address:
  • Phone: 818-986-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: