Provider Demographics
NPI:1497037774
Name:TOWNSEND, STUART E (PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:E
Last Name:TOWNSEND
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 1:9 SAINT JOHNS MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5343
Mailing Address - Country:US
Mailing Address - Phone:904-797-2705
Mailing Address - Fax:904-797-2820
Practice Address - Street 1:9 SAINT JOHNS MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5343
Practice Address - Country:US
Practice Address - Phone:904-797-2705
Practice Address - Fax:904-797-2820
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical