Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY00002443 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY00002443 | WA |
N | 103G00000X | Clinical Psychologist | PY00002443 | WA |
N | 103TC0700X | Clinical Psychologist | PY00002443 | WA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY00002443 | WA |
NPI | 1366781932 |
---|---|
Provider Name | Dr. David Gage Stewart |
First Address | Seattle, WA 98106-2919 |
Second Address | Cambridge, MA 02139-1047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2013 |
Last Update Date | 15/06/2017 |