Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS015707 | PA |
N | 103TC0700X | Clinical Psychologist | PS015707 | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS015707 | PA |
N | 103TF0200X | Forensic Psychologist | PS015707 | PA |
NPI | 1124197884 |
---|---|
Provider Name | Dr. Brandi Jo Stewart |
First Address | Philadelphia, PA 19123-2804 |
Second Address | Philadelphia, PA 19115-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |