Provider Demographics
NPI:1497504591
Name:LOFARO, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:LOFARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OCEAN AVE UNIT 1010B
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1467
Mailing Address - Country:US
Mailing Address - Phone:310-720-7578
Mailing Address - Fax:
Practice Address - Street 1:201 OCEAN AVE UNIT 1010B
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-1467
Practice Address - Country:US
Practice Address - Phone:310-720-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT36646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist