Provider Demographics
NPI:1033429592
Name:STEWART, LISA MELANIE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MELANIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MELANIE
Other - Last Name:FAVORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:721 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-7163
Mailing Address - Country:US
Mailing Address - Phone:270-998-1057
Mailing Address - Fax:
Practice Address - Street 1:721 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-7163
Practice Address - Country:US
Practice Address - Phone:270-998-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000041081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical