Provider Demographics
NPI:1639059066
Name:LONAKER, STACIE KIMBERLY
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:KIMBERLY
Last Name:LONAKER
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 1:334 SANTANA ROW APT 232
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2019
Mailing Address - Country:US
Mailing Address - Phone:408-500-5946
Mailing Address - Fax:
Practice Address - Street 1:1889 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2166
Practice Address - Country:US
Practice Address - Phone:408-423-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT123808106H00000X
CALPCC18274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist