1700290962 NPI number — NEW DIRECTIONS FOR YOUNG ADULTS - CALIFORNIA

Table of content: DR. STEPHENIE ADYNE LAFAVE SPENCER M.S., PSY.D. (NPI 1639665250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700290962 NPI number — NEW DIRECTIONS FOR YOUNG ADULTS - CALIFORNIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DIRECTIONS FOR YOUNG ADULTS - CALIFORNIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700290962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3275 W. HILLSBORO BLVD
Provider Second Line Business Mailing Address:
STE. 110
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-571-5102
Provider Business Mailing Address Fax Number:
954-571-5265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LONGBROOK WAY
Provider Second Line Business Practice Location Address:
STE. 20
Provider Business Practice Location Address City Name:
PLEASANT HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-763-5102
Provider Business Practice Location Address Fax Number:
954-571-5265
Provider Enumeration Date:
06/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RUBIN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
SETH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-778-7808

Provider Taxonomy Codes

  • Taxonomy code: 103TM1800X , with the licence number:  PSY 15497 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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