Mario Antonio Souza, PSY.D.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

License

D6738240 Issued in CA

Practice address

3102 E Highland Ave
Patton, CA 92369-7813

Phone

(909) 425-7000

NPI assigned

Jun 15, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1386083012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3404 SANTA CARLOTTA ST",
            "city": "LA CRESCENTA",
            "state": "CA",
            "postal_code": "912141158",
            "telephone_number": "818-395-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 E HIGHLAND AVE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "923697813",
            "telephone_number": "909-425-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUZA",
        "first_name": "MARIO",
        "middle_name": "ANTONIO",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-15",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "D6738240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathy R Sink, PH.D.
• Sheena J Smith, LCSW
• Kasmira J Sobkow, PSY.D.
• Jeffrey L Soriano, LCSW
• Krista Tiscione Soto, PSY.D.
• Brenda Marie Starkins, LCSW
• Darrell W Steinmetz, LCSW
• Lauren Stevenson, PSY.D.
• Barbara Jean Strong, M.D.
• Sandy Suarez, LCSW

• Forensic Psychologist in Patton, CA
• Providers in Patton, CA by specialty
• Forensic Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.