Basic Information
| Provider Information | |||||||||
| NPI: | 1033699319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINILLA | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 E PLYMOUTH ST | ||||||||
| Address2: | |||||||||
| City: | INGLEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 903022416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104154124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 S LAFAYETTE PARK PLACE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132522100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 90474 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.