Provider Demographics
NPI:1730252461
Name:CARMICHAEL, STEVEN ROSS (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROSS
Last Name:CARMICHAEL
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 1:706 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2414
Mailing Address - Country:US
Mailing Address - Phone:209-577-1667
Mailing Address - Fax:209-577-3805
Practice Address - Street 1:706 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2414
Practice Address - Country:US
Practice Address - Phone:209-577-1667
Practice Address - Fax:209-577-3805
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical