| Stacey Datnow, Lcsw, Inc. | |
|
28348 Roadside Dr Ste 201 Agoura Hills CA 91301-2596 | |
| (818) 276-3242 | |
| (818) 699-6053 |
| Full Name | Stacey Datnow, Lcsw, Inc. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 28348 Roadside Dr Ste 201, Agoura Hills, California |
| Authorized Official Name and Position | Stacey Fran Datnow (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 3109900307 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey Datnow, Lcsw, Inc. 28348 Roadside Dr Ste 201 Agoura Hills CA 91301-2596 Ph: (310) 990-0307 | Stacey Datnow, Lcsw, Inc. 28348 Roadside Dr Ste 201 Agoura Hills CA 91301-2596 Ph: (818) 276-3242 |
| NPI Number | 1568078061 |
|---|---|
| Provider Enumeration Date | 09/20/2020 |
| Last Update Date | 10/22/2020 |
| Certification Date | 10/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568078061 | NPI | - | NPPES |
| 1295836963 | Other | CA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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