Provider Demographics
NPI:1376895243
Name:PARKER, STEVE LE FAY (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:LE FAY
Last Name:PARKER
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 CASA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2506
Mailing Address - Country:US
Mailing Address - Phone:909-915-8136
Mailing Address - Fax:
Practice Address - Street 1:3118 CASA LOMA DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2506
Practice Address - Country:US
Practice Address - Phone:909-915-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27610OtherBOARD OF BEHAVIORAL SCIENCES