Provider Demographics
NPI:1063448348
Name:STEWART, GWENDOLYN FAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:FAYE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E RUSSELL RD STE 314
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:702-305-4376
Mailing Address - Fax:702-924-8000
Practice Address - Street 1:3430 E RUSSELL RD STE 314
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:702-305-4376
Practice Address - Fax:702-924-8000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8713-C1041C0700X
LA47241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical