Provider Demographics
NPI:1528087566
Name:STWERTKA, STEVEN A (PHD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:STWERTKA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3099 HELMSDALE PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2213
Mailing Address - Country:US
Mailing Address - Phone:859-258-6401
Mailing Address - Fax:859-255-1480
Practice Address - Street 1:3099 HELMSDALE PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2213
Practice Address - Country:US
Practice Address - Phone:859-258-6401
Practice Address - Fax:859-255-1480
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GROUP
KY0971005Medicare ID - Type Unspecified
R70955Medicare UPIN