Provider Demographics
NPI:1023264132
Name:STUART, DALE (PHD, SCD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:PHD, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 KONYA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2406
Mailing Address - Country:US
Mailing Address - Phone:310-371-3543
Mailing Address - Fax:
Practice Address - Street 1:3510 TORRANCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-371-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist