Provider Demographics
NPI:1821149931
Name:KAYRA-STUART, FORTUNEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FORTUNEE
Middle Name:
Last Name:KAYRA-STUART
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 1:791A TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1026
Mailing Address - Country:US
Mailing Address - Phone:510-526-9506
Mailing Address - Fax:510-526-9506
Practice Address - Street 1:2550 9TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2549
Practice Address - Country:US
Practice Address - Phone:510-526-9506
Practice Address - Fax:510-526-9506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9810103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist