Individual provider · Type 1 NPI
Stephanie Marie Deatherage
Clinical Social Worker · Costa Mesa, CA
Practice location
3505 Cadillac Avenue, Building O, Suite 110
Costa Mesa, CA 92626-1429
Mailing address
21881 Ute Way
Lake Forest, CA 92630-3548
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Social Worker Primary | 1041C0700X | LCSW129363 (CA) |
Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…
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- Brian JacoboClinical Social Worker Costa Mesa, CA NPI 1033741541
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About NPI 1669090346
Stephanie Marie Deatherage's National Provider Identifier is 1669090346, issued on Jul 9, 2020. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Costa Mesa, CA. The record was last updated on Apr 8, 2025.