Provider Demographics
NPI:1184608523
Name:EMERICK, STEPHEN WAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WAYNE
Last Name:EMERICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9863 ARN DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4144
Mailing Address - Country:US
Mailing Address - Phone:937-271-9560
Mailing Address - Fax:
Practice Address - Street 1:9863 ARN DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-4144
Practice Address - Country:US
Practice Address - Phone:937-271-9560
Practice Address - Fax:937-439-3747
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4189103T00000X
OH90281CCDCIII103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184608523Medicaid
OH0738027Medicaid
OH0738027Medicaid