Provider Demographics
NPI:1801104963
Name:MADRID, STEVEN (PSY D & MASTER ADD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:MADRID
Suffix:
Gender:M
Credentials:PSY D & MASTER ADD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 E. 4TH ST. #133
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-542-6044
Mailing Address - Fax:714-542-6044
Practice Address - Street 1:1651 E. 4TH ST
Practice Address - Street 2:133
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-542-6044
Practice Address - Fax:714-542-6044
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032546101YA0400X
CAMFC37264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)