Provider Demographics
NPI:1164799672
Name:WECHTER, STUART JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:JAY
Last Name:WECHTER
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 1:4 FOWLER PL
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6610
Mailing Address - Country:US
Mailing Address - Phone:631-667-5613
Mailing Address - Fax:
Practice Address - Street 1:4 FOWLER PL
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6610
Practice Address - Country:US
Practice Address - Phone:631-667-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004317-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist