MEDICARE: MS. VICTORIA MAXINE STEFANI MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC44496	CA

General Provider Information

NPI Number	:	1306022710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA MAXINE STEFANI MFT

Provider Business Mailing Address
First Line	:	320 10TH ST
Second Line	:	SUITE 205
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5291
Country	:	US
Telephone Number	:	707-545-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 10TH ST
Second Line	:	SUITE 205
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5291
Country	:	US
Telephone Number	:	707-545-6009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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