Provider Demographics
NPI:1043713159
Name:STERNBERG, CARL FRANK (PHD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:FRANK
Last Name:STERNBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 30TH ST STE 1-212
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1029
Mailing Address - Country:US
Mailing Address - Phone:303-938-8188
Mailing Address - Fax:
Practice Address - Street 1:1525 SPRUCE ST STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4256
Practice Address - Country:US
Practice Address - Phone:303-938-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
881OtherSTATE OF COLORADO PSYCHOLOGIST LICENSE