Provider Demographics
NPI:1508076217
Name:STEWART, DENTON JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENTON
Middle Name:JAY
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 1:121 HUNTER AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2083
Mailing Address - Country:US
Mailing Address - Phone:314-725-6688
Mailing Address - Fax:314-721-7109
Practice Address - Street 1:121 HUNTER AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2083
Practice Address - Country:US
Practice Address - Phone:314-725-6688
Practice Address - Fax:314-721-7109
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist