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NPI Code Detail

MEDICARE: DR. TIFFANY MAE STEWART PH.D.

MEDICARE: DR. TIFFANY MAE STEWART PH.D.
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
1103TC0700XClinical Psychologist1069LA

General Provider Information

NPI Number : 1548727704
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIFFANY MAE STEWART PH.D.
Provider Business Mailing Address
First Line : 6400 PERKINS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-0102
Country : US
Telephone Number : 225-763-2554
Fax Number :
Provider Business Practice Location Address
First Line : 6400 PERKINS RD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-0102
Country : US
Telephone Number : 225-763-2554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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