Provider Demographics
NPI:1871781005
Name:MAZER, STEFANIE B (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:B
Last Name:MAZER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3423
Mailing Address - Country:US
Mailing Address - Phone:323-789-6492
Mailing Address - Fax:323-967-0180
Practice Address - Street 1:8401 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3423
Practice Address - Country:US
Practice Address - Phone:323-789-6492
Practice Address - Fax:323-967-0180
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner