Provider Demographics
NPI:1538482468
Name:YOSLOW, MARK LUCIUS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LUCIUS
Last Name:YOSLOW
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 1:970 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2421
Mailing Address - Country:US
Mailing Address - Phone:650-269-0626
Mailing Address - Fax:
Practice Address - Street 1:970 MINNESOTA AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:650-269-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2012-02-07
Deactivation Date:2011-03-31
Deactivation Code:
Reactivation Date:2012-02-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist