Provider Demographics
NPI:1699881201
Name:STEWART, DAVID L (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:STEWART
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 1:970 CAMERADO DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7636
Mailing Address - Country:US
Mailing Address - Phone:530-676-7091
Mailing Address - Fax:530-676-7092
Practice Address - Street 1:970 CAMERADO DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7636
Practice Address - Country:US
Practice Address - Phone:530-676-7091
Practice Address - Fax:530-676-7092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13088103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist