Provider Demographics
NPI:1356532287
Name:ALCANTARA, STEPHANIE (MA, MFTI, PCCI)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:MA, MFTI, PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 COTTLE RD BLDG 4
Mailing Address - Street 2:5755 COTTLE ROAD, BUILDING #4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3640
Mailing Address - Country:US
Mailing Address - Phone:408-972-3095
Mailing Address - Fax:408-972-3242
Practice Address - Street 1:5755 COTTLE RD BLDG 4
Practice Address - Street 2:5755 COTTLE ROAD, BUILDING #4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3640
Practice Address - Country:US
Practice Address - Phone:408-972-3095
Practice Address - Fax:408-972-3242
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA951101YP2500X
CA77979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional