Provider Demographics
NPI:1396134409
Name:STERN-ELLIS, DEBRA MICHELE (LCSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MICHELE
Last Name:STERN-ELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MICHELE
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4647 ZION AVE KAISER PERMANENTE,
Mailing Address - Street 2:2ND FLOOR - ONCOLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-528-3152
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVENUE KAISER PERMANENTE,
Practice Address - Street 2:2ND FLOOR - ONCOLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-528-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS166091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical