Provider Demographics
NPI:1306936711
Name:STEIN, STEVEN A (PHD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:STEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 BRYN MAWR ST 1
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-7708
Mailing Address - Country:US
Mailing Address - Phone:330-221-2088
Mailing Address - Fax:
Practice Address - Street 1:308 BRYN MAWR ST
Practice Address - Street 2:UNIT I
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-7708
Practice Address - Country:US
Practice Address - Phone:330-221-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978198Medicaid
OHCP14201Medicare PIN