Provider Demographics
NPI:1881750271
Name:HOCKENBERRY, STEWART (PHD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:HOCKENBERRY
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 1:409 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2015
Mailing Address - Country:US
Mailing Address - Phone:215-576-1728
Mailing Address - Fax:215-576-1728
Practice Address - Street 1:255 S 17TH ST STE 1909
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6219
Practice Address - Country:US
Practice Address - Phone:215-576-1728
Practice Address - Fax:215-576-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008448L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA243596OtherMANAGED HEALTH NETWORK
PA0102891000OtherPERSONAL CHOICE PROVIDER
PA7543181OtherAETNA HEALTH CARE
PAH0122450OtherINDEPENDENCE BLUE CROSS
PA158128OtherVALUE OPTIONS
PA243596OtherMANAGED HEALTH NETWORK