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Individual

STACEY FONSECA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSY.D.

Contact information

Practice address
9200 COLIMA RD, SUITE 206, WHITTIER, CA 90605-1814
(562) 945-5454
Mailing address
PO BOX 2364, COVINA, CA 91722-8364

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PSY26644
CA
103TC0700X
Clinical Psychologist
PSY26644
CA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY26644
CA

Other

Enumeration date
06/03/2011
Last updated
08/26/2016
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