Provider Demographics
NPI:1447466933
Name:LARRO, STEPHANIE DEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DEE
Last Name:LARRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15165 VENTURA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3373
Mailing Address - Country:US
Mailing Address - Phone:818-346-7855
Mailing Address - Fax:
Practice Address - Street 1:15165 VENTURA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3373
Practice Address - Country:US
Practice Address - Phone:818-346-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW17544Medicare PIN