Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003176249 |
---|---|
Provider Name | Stefanie Fajardo |
First Address | Los Angeles, CA 90005-4016 |
Second Address | Los Angeles, CA 90005-4016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 13/02/2020 |