MEDICARE: MS. JUDITH A STEWART PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY13946	CA

General Provider Information

NPI Number	:	1477883460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH A STEWART PHD

Provider Business Mailing Address
First Line	:	4004 VIA VALMONTE
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1409
Country	:	US
Telephone Number	:	310-791-1643
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 VIA EL PRADO
Second Line	:	SUITE 201
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5722
Country	:	US
Telephone Number	:	310-540-3586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	01/13/2010

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