MEDICARE: JUSTINE STEWART PSYD

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	103TH0004X	Health Psychologist	07377	MD
2	103TH0004X	Health Psychologist	071.022670	IL

General Provider Information

NPI Number	:	1548105307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE STEWART PSYD

Provider Business Mailing Address
First Line	:	1351 S HALSTED ST UNIT 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-5006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 S HALSTED ST UNIT 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-5006
Country	:	US
Telephone Number	:	708-209-9830
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ JUSTINE STEWART PSYD” Practice Location

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