Provider Demographics
NPI:1609200385
Name:BARAJAS, MARK STEVEN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 ST. MARY'S ROAD
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94575-2744
Mailing Address - Country:US
Mailing Address - Phone:925-631-8009
Mailing Address - Fax:
Practice Address - Street 1:2140 SHATTUCK AVE STE 809
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1229
Practice Address - Country:US
Practice Address - Phone:510-969-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015413103TC1900X
CA30042103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling