Provider Demographics
NPI:1184716714
Name:STUART, RICHARD ALLEN (DED)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:STUART
Suffix:
Gender:M
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 REGENT CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-237-0551
Mailing Address - Fax:814-237-0564
Practice Address - Street 1:110 REGENT CT
Practice Address - Street 2:SUITE 103
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-237-0551
Practice Address - Fax:814-237-0564
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004627L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50000768OtherCBC
PA2057246OtherGHI
PA470368OtherBLUE SHIELD
PA280043OtherHEALTH AMER
PA2057246OtherGHI