| Doctor Name: | MRS. STEPHANIE CATHERINE VIDAURRI |
| NPI Number: | 1790121176 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | LCSW 3734 |
| Business Practice Address: | 498 Chalan Palosyo Guam Va Cboc Agana Heights, GU - 969106427 |
| Business Phone Number: | 6714755800 |
| Business Fax Number: | |
| Mailing Address: | 8 Anae Ln, SANTA RITA |
| State: | GU |
| Postal Code: | 969151433 |
| Phone Number: | 6715641789 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2013 |
| NPI Last Update Date: | 05/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSW 3734 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |