Healthcare Provider Details

I. General information

NPI: 1962648337
Provider Name (Legal Business Name): STUART WALTER QUIRK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 COOPER ST
CINCINNATI OH
45223-2616
US

IV. Provider business mailing address

1612 COOPER ST
CINCINNATI OH
45223-2616
US

V. Phone/Fax

Practice location:
  • Phone: 989-854-6486
  • Fax: 864-428-2275
Mailing address:
  • Phone: 989-854-6486
  • Fax: 864-428-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.09024
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1461
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: