Provider Demographics
NPI:1629367230
Name:STEIN, NATHANIEL DAVID (MT-BC, NMT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:DAVID
Last Name:STEIN
Suffix:
Gender:M
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 S WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3371
Mailing Address - Country:US
Mailing Address - Phone:408-768-6668
Mailing Address - Fax:
Practice Address - Street 1:473 S WILLARD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3371
Practice Address - Country:US
Practice Address - Phone:408-768-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09536225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist