Basic Information
| Provider Information | |||||||||
| NPI: | 1275731507 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURILLO | ||||||||
| FirstName: | STEFANY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E WALNUT ST | ||||||||
| Address2: | 3RD FLOOR - PHR SYSTEMS | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264057914 | ||||||||
| FaxNumber: | 6264056768 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 BALDWIN PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917065806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268511011 | ||||||||
| FaxNumber: | 6264056768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2007 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MFC37579 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.