Basic Information
| Provider Information | |||||||||
| NPI: | 1295270676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 900 FIFTH AVENUE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ; SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154576964 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 900 FIFTH AVENUE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | ; SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154576964 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2016 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.