Provider Demographics
NPI:1609091974
Name:STERN, DAVID J (PHYSD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:STERN
Suffix:
Gender:M
Credentials:PHYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1143
Mailing Address - Country:US
Mailing Address - Phone:401-274-2844
Mailing Address - Fax:
Practice Address - Street 1:341 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1143
Practice Address - Country:US
Practice Address - Phone:401-274-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist