Provider Demographics
NPI:1346309440
Name:HOWARD, MARK LESTER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LESTER
Last Name:HOWARD
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 1:611 ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1608
Mailing Address - Country:US
Mailing Address - Phone:650-255-0460
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 611
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3928
Practice Address - Country:US
Practice Address - Phone:650-255-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6581103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist