Provider Demographics
NPI:1457870693
Name:BARROSO, STEVE
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:BARROSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E MAIN ST STE 307
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2908
Mailing Address - Country:US
Mailing Address - Phone:209-478-4554
Mailing Address - Fax:209-478-1991
Practice Address - Street 1:306 E MAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2908
Practice Address - Country:US
Practice Address - Phone:209-478-4554
Practice Address - Fax:209-478-1991
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
101YM0800X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health