Provider Demographics
NPI:1245365345
Name:STUART, BRYAN R (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:STUART
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 1:244 WASHINGTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4208
Mailing Address - Country:US
Mailing Address - Phone:212-729-1813
Mailing Address - Fax:
Practice Address - Street 1:380 LAFAYETTE ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6906
Practice Address - Country:US
Practice Address - Phone:212-729-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical