Provider Demographics
NPI:1003993205
Name:STEWART, CHERISE A (MA)
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:A
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHERISE
Other - Middle Name:A
Other - Last Name:CARBONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1060 LINCOLN AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3110
Mailing Address - Country:US
Mailing Address - Phone:408-645-0891
Mailing Address - Fax:
Practice Address - Street 1:1040 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-293-4493
Practice Address - Fax:408-293-6188
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB6781531106H00000X
CA50851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist