Provider Demographics
NPI:1730714759
Name:STOKER, PAIGE BRAITHWAITE (MA)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:BRAITHWAITE
Last Name:STOKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30712 PRINCIPIO DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3138
Mailing Address - Country:US
Mailing Address - Phone:310-963-5720
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 205
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9134
Practice Address - Country:US
Practice Address - Phone:805-798-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist