Provider Demographics
NPI:1740200245
Name:FOERSTNER, STACEY BREWSTER (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BREWSTER
Last Name:FOERSTNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9747
Mailing Address - Country:US
Mailing Address - Phone:440-256-1619
Mailing Address - Fax:
Practice Address - Street 1:34950 CHARDON RD
Practice Address - Street 2:SUITE #202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9162
Practice Address - Country:US
Practice Address - Phone:440-510-5100
Practice Address - Fax:440-510-5151
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3859103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664099Medicaid
OH0664099Medicaid