Healthcare Provider Details

I. General information

NPI: 1144405572
Provider Name (Legal Business Name): DAVID EDWARD STUCKEY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17900 SKY PARK CIR SUITE 220
IRVINE CA
92614-6436
US

IV. Provider business mailing address

17900 SKY PARK CIR SUITE 220
IRVINE CA
92614-6436
US

V. Phone/Fax

Practice location:
  • Phone: 415-902-6320
  • Fax:
Mailing address:
  • Phone: 415-902-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21628
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPSY21628
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY21628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: