MEDICARE: DR. STACEY BREWSTER FOERSTNER 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
1	103T00000X	Psychologist	3859	OH

General Provider Information

NPI Number	:	1740200245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY BREWSTER FOERSTNER PH.D.

Provider Business Mailing Address
First Line	:	8585 CARDINAL DR
Second Line	:
City	:	KIRTLAND
State	:	OH
Zip	:	44094-9747
Country	:	US
Telephone Number	:	440-256-1619
Fax Number	:

Provider Business Practice Location Address
First Line	:	34950 CHARDON RD STE 202
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-9162
Country	:	US
Telephone Number	:	440-477-1007
Fax Number	:	440-753-0148

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/12/2026

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