Healthcare Provider Details

I. General information

NPI: 1366781932
Provider Name (Legal Business Name): DAVID GAGE STEWART PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2013
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

9609 13TH AVE SW
SEATTLE WA
98106-2919
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-5336
  • Fax:
Mailing address:
  • Phone: 206-354-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPY00002443
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY00002443
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002443
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY00002443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: