Basic Information
| Provider Information | |||||||||
| NPI: | 1194241141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAHYADI | ||||||||
| FirstName: | STEFANY | ||||||||
| MiddleName: | ANDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 COOLIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946023311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104855210 | ||||||||
| FaxNumber: | 5108420406 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 W 25TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944032208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502862090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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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 | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.