Provider Demographics
NPI:1770677387
Name:HENDLIN, STEVEN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:HENDLIN
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 1:230 NEWPORT CENTER DR.
Mailing Address - Street 2:#220
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7533
Mailing Address - Country:US
Mailing Address - Phone:949-644-7707
Mailing Address - Fax:949-720-0940
Practice Address - Street 1:230 NEWPORT CENTER DR.
Practice Address - Street 2:#220
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7533
Practice Address - Country:US
Practice Address - Phone:949-644-7707
Practice Address - Fax:949-720-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5019103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
33-0138485OtherFED. TAX ID