MEDICARE: DR. RICHARD LIONEL STEWART JR. 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	103TC0700X	Clinical Psychologist	PY0005669	FL
2	103TF0200X	Forensic Psychologist	PY0005669	FL

General Provider Information

NPI Number	:	1811903917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LIONEL STEWART JR. PH.D.

Provider Business Mailing Address
First Line	:	272 FAIRWAY ISLES LN
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-9325
Country	:	US
Telephone Number	:	941-748-4739
Fax Number	:	941-747-6267

Provider Business Practice Location Address
First Line	:	677 N WASHINGTON BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-4241
Country	:	US
Telephone Number	:	941-747-6267
Fax Number	:	941-747-6267

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	09/11/2025

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