Provider Demographics
NPI:1134261100
Name:SOOTER, STEPHEN (MS, RAS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SOOTER
Suffix:
Gender:M
Credentials:MS, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1569
Mailing Address - Country:US
Mailing Address - Phone:925-948-8776
Mailing Address - Fax:
Practice Address - Street 1:2380 ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1569
Practice Address - Country:US
Practice Address - Phone:925-948-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAPSB36626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)