Provider Demographics
NPI:1457806226
Name:MAURO, STEVEN DALE
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DALE
Last Name:MAURO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 S D ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3257
Mailing Address - Country:US
Mailing Address - Phone:909-388-2228
Mailing Address - Fax:
Practice Address - Street 1:1585 S D ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3257
Practice Address - Country:US
Practice Address - Phone:909-388-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist