MEDICARE: STEPHANIE TRIANA, PH.D.

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	103TC0700X	Clinical Psychologist	36505	TX

General Provider Information

NPI Number	:	1467991794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHANIE TRIANA, PH.D.

Provider Business Mailing Address
First Line	:	21015 LA PENA DR
Second Line	:	106
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2935
Country	:	US
Telephone Number	:	210-663-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1846 LOCKHILL SELMA RD
Second Line	:	106
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1570
Country	:	US
Telephone Number	:	210-663-9800
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	STEPHANIE TRIANA
Credential	:	PH.D.
Telephone Number	:	210-663-9800

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	02/20/2017

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