Healthcare Provider Details

I. General information

NPI: 1548105307
Provider Name (Legal Business Name): JUSTINE STEWART PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 S HALSTED ST UNIT 206
CHICAGO IL
60607-5006
US

IV. Provider business mailing address

1351 S HALSTED ST UNIT 206
CHICAGO IL
60607-5006
US

V. Phone/Fax

Practice location:
  • Phone: 708-209-9830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number07377
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number071.022670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: