Provider Demographics
NPI:1508433699
Name:WARE, STEPHEN L JR
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:WARE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N MAIN ST UNIT 341
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3431
Mailing Address - Country:US
Mailing Address - Phone:909-210-0701
Mailing Address - Fax:
Practice Address - Street 1:418 N MAIN ST UNIT 341
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-3431
Practice Address - Country:US
Practice Address - Phone:909-210-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty