Provider Demographics
NPI:1861774234
Name:VILLASENOR, STEPHANIE R (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:VILLASENOR
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 1:4290 RALL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-6938
Mailing Address - Country:US
Mailing Address - Phone:559-259-2350
Mailing Address - Fax:559-259-2350
Practice Address - Street 1:4290 RALL AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-6938
Practice Address - Country:US
Practice Address - Phone:559-259-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1291571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical