Provider Demographics
NPI:1144436908
Name:SEXTON, MARK C (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:SEXTON
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 1:29 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1026
Mailing Address - Country:US
Mailing Address - Phone:415-370-4294
Mailing Address - Fax:415-270-4911
Practice Address - Street 1:2409 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2225
Practice Address - Country:US
Practice Address - Phone:415-675-9970
Practice Address - Fax:415-490-2711
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical