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General NPI Number Information
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NPI Number | 1568078061
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Entity Type | Organization
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Legal Business Name | STACEY DATNOW, LCSW, INC.
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Dates
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Enumeration Date | 09/20/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 28348 ROADSIDE DR STE 201
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City | AGOURA HILLS
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State | CA
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Zip | 91301-2596
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Country | US
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Telephone | 818-276-3242
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Fax | 818-699-6053
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Provider Business Mailing Address
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Address Line | 28348 ROADSIDE DR STE 201
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City | AGOURA HILLS
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State | CA
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Zip | 91301-2596
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Country | US
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Telephone | 310-990-0307
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Fax | 818-699-6053
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | STACEY FRAN DATNOW
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Credential | LCSW
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Telephone | 310-990-0307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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