Healthcare Provider Details

I. General information

NPI: 1124671201
Provider Name (Legal Business Name): ANDREAS PATRICK STOCKER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 S FLAGLER AVE
FLAGLER BEACH FL
32136-4000
US

IV. Provider business mailing address

PO BOX 2228
FLAGLER BEACH FL
32136-2228
US

V. Phone/Fax

Practice location:
  • Phone: 386-569-0893
  • Fax:
Mailing address:
  • Phone: 386-569-0893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY13195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: