MEDICARE: STEPHANIE CRAIG LCSW

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	1041C0700X	Clinical Social Worker	LCSW94937	CA

General Provider Information

NPI Number	:	1720778954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CRAIG LCSW

Provider Business Mailing Address
First Line	:	2127 COASTLAND AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2608
Country	:	US
Telephone Number	:	415-686-1956
Fax Number	:

Provider Business Practice Location Address
First Line	:	2127 COASTLAND AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-2608
Country	:	US
Telephone Number	:	415-686-1956
Fax Number	:

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	05/18/2023

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