MEDICARE: AUTUMN STEPHENS

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	125788	CA

General Provider Information

NPI Number	:	1922620814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN STEPHENS

Provider Business Mailing Address
First Line	:	920 10TH ST
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-4339
Country	:	US
Telephone Number	:	310-920-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 VIA EL PRADO STE 204
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5721
Country	:	US
Telephone Number	:	310-920-1817
Fax Number	:

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

Provider Enumeration Date	:	05/13/2020
Last Update Date	:	10/01/2024

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Directions to “ AUTUMN STEPHENS ” Practice Location

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