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: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NORTHERN BLVD STE 416
GREAT NECK NY
11021-5330
US

IV. Provider business mailing address

1010 NORTHERN BLVD STE 416
GREAT NECK NY
11021-5330
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-7116
  • Fax: 515-829-1731
Mailing address:
  • Phone: 516-487-7116
  • Fax: 515-829-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number028414
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY13195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: