Provider Demographics
NPI:1669682308
Name:STOCK, VINCENT F (MA)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:F
Last Name:STOCK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2878
Mailing Address - Country:US
Mailing Address - Phone:314-503-7755
Mailing Address - Fax:636-916-5440
Practice Address - Street 1:201 N MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2878
Practice Address - Country:US
Practice Address - Phone:314-503-7755
Practice Address - Fax:636-916-5440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY 01633103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral