Provider Demographics
NPI:1811224363
Name:BLAIN, STEWART (PSYD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:BLAIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3803
Mailing Address - Country:US
Mailing Address - Phone:510-393-8108
Mailing Address - Fax:
Practice Address - Street 1:149 AMHERST AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3803
Practice Address - Country:US
Practice Address - Phone:510-393-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist