Provider Demographics
NPI:1699375584
Name:GERSTEIN, STUART DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:DAVID
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2205
Mailing Address - Country:US
Mailing Address - Phone:610-642-2802
Mailing Address - Fax:
Practice Address - Street 1:608 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2205
Practice Address - Country:US
Practice Address - Phone:610-642-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty