Provider Demographics
NPI:1538864822
Name:COLLINS, STEPHANIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:COLLINS
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:PO BOX 190612
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94119-0612
Mailing Address - Country:US
Mailing Address - Phone:415-595-9192
Mailing Address - Fax:415-749-1433
Practice Address - Street 1:1625 VAN NESS AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3369
Practice Address - Country:US
Practice Address - Phone:415-600-6272
Practice Address - Fax:415-749-1433
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW290601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical