Provider Demographics
NPI:1891982534
Name:STECKDAUB, MARTIN EUGENE (RAS, CADC, CSC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:EUGENE
Last Name:STECKDAUB
Suffix:
Gender:M
Credentials:RAS, CADC, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12553 VENICE BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3712
Mailing Address - Country:US
Mailing Address - Phone:310-754-9086
Mailing Address - Fax:
Practice Address - Street 1:42225 REMINGTON AVE.
Practice Address - Street 2:SUITE 18
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2563
Practice Address - Country:US
Practice Address - Phone:951-587-4296
Practice Address - Fax:951-587-4194
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS0007170802101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)