Provider Demographics
NPI:1518232644
Name:STEINBERG, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:STEINBERG
Suffix:
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 1:14601 S BASCOM AVE
Mailing Address - Street 2:STE. 250
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2043
Mailing Address - Country:US
Mailing Address - Phone:408-356-1002
Mailing Address - Fax:
Practice Address - Street 1:14601 S BASCOM AVE
Practice Address - Street 2:STE. 250
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2043
Practice Address - Country:US
Practice Address - Phone:408-356-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12170103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist