Provider Demographics
NPI:1073723870
Name:PRATT, MARK (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:PHD, MS
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 20008
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94309-0008
Mailing Address - Country:US
Mailing Address - Phone:650-321-1085
Mailing Address - Fax:650-463-5775
Practice Address - Street 1:703 WELCH ROAD,
Practice Address - Street 2:SUITE F-6
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-321-1085
Practice Address - Fax:650-463-5775
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical