Healthcare Provider Details

I. General information

NPI: 1922247279
Provider Name (Legal Business Name): DEBRA JENNIFER STERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6455 COLDWATER CANYON AVE
VALLEY GLEN CA
91606-1112
US

IV. Provider business mailing address

13130 BURBANK BLVD
SHERMAN OAKS CA
91401-6000
US

V. Phone/Fax

Practice location:
  • Phone: 818-623-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94026905
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: