Healthcare Provider Details

I. General information

NPI: 1669210050
Provider Name (Legal Business Name): STEPHEN F MARTON PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST
SAN QUENTIN CA
94964
US

IV. Provider business mailing address

9214 WOODLAND DR
SILVER SPRING MD
20910-1518
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-1460
  • Fax:
Mailing address:
  • Phone: 240-898-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: