Provider Demographics
NPI:1174576540
Name:STEIN, MARK R (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:STEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:2000 REGENCY PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8507
Mailing Address - Country:US
Mailing Address - Phone:919-469-2800
Mailing Address - Fax:919-469-8294
Practice Address - Street 1:2000 REGENCY PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8507
Practice Address - Country:US
Practice Address - Phone:919-469-2800
Practice Address - Fax:919-469-8294
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC1032103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2810591AMedicare PIN