Provider Demographics
NPI:1801925136
Name:ZITLIN, MARK R (PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:ZITLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 BROADWAY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5734
Mailing Address - Country:US
Mailing Address - Phone:210-822-5795
Mailing Address - Fax:210-822-5935
Practice Address - Street 1:4901 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5734
Practice Address - Country:US
Practice Address - Phone:210-822-5795
Practice Address - Fax:210-822-5935
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical