Healthcare Provider Details

I. General information

NPI: 1881750271
Provider Name (Legal Business Name): STEWART HOCKENBERRY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST STE 1909
PHILADELPHIA PA
19103-6219
US

IV. Provider business mailing address

409 CARLTON AVE
WYNCOTE PA
19095-2015
US

V. Phone/Fax

Practice location:
  • Phone: 215-576-1728
  • Fax: 215-576-1728
Mailing address:
  • Phone: 215-576-1728
  • Fax: 215-576-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS008448L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: