Healthcare Provider Details

I. General information

NPI: 1255493565
Provider Name (Legal Business Name): STEPHEN ROGER SETTERBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 COLBY ST STE 221
BERKELEY CA
94705-2056
US

IV. Provider business mailing address

12915 63RD AVE N
MAPLE GROVE MN
55369-6001
US

V. Phone/Fax

Practice location:
  • Phone: 844-763-3560
  • Fax: 510-680-1849
Mailing address:
  • Phone: 763-383-5800
  • Fax: 763-383-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number36051
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG-147958
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36051
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG-147958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: