Provider Demographics
NPI:1033252093
Name:STUART, RICHARD B (DSW)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:STUART
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-0236
Mailing Address - Country:US
Mailing Address - Phone:425-771-4548
Mailing Address - Fax:
Practice Address - Street 1:6869 WOODLAWN AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5469
Practice Address - Country:US
Practice Address - Phone:425-771-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001407103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist