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General NPI Number Information
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NPI Number | 1548574965
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Entity Type | Individual
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Provider Name | STACY S. FORCINO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 05/30/2015
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Provider Practice Location Address
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Address Line | 18484 US HIGHWAY 18 STE 210
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2375
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Country | US
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Telephone | 760-995-5134
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Fax | 888-843-0969
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Provider Business Mailing Address
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Address Line | 18484 US HIGHWAY 18 STE 210
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2375
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Country | US
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Telephone | 760-995-5134
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Fax | 888-843-0969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 25509
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License Number State | CA
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