Provider Demographics
NPI:1730638131
Name:STEFANO, AQUA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AQUA
Middle Name:
Last Name:STEFANO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251-0674
Mailing Address - Country:US
Mailing Address - Phone:858-352-8840
Mailing Address - Fax:
Practice Address - Street 1:1006 NW 47TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4759
Practice Address - Country:US
Practice Address - Phone:858-352-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201051041C0700X
390200000X
CA1125001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program