Provider Demographics
NPI:1073682746
Name:STEWART, EDWINA MARIE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7299 COACHLIGHT CT
Mailing Address - Street 2:UNIT C
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-9422
Mailing Address - Country:US
Mailing Address - Phone:301-668-0481
Mailing Address - Fax:301-668-0481
Practice Address - Street 1:7299 COACHLIGHT CT
Practice Address - Street 2:UNIT C
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-9422
Practice Address - Country:US
Practice Address - Phone:301-668-0481
Practice Address - Fax:301-668-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD744RMedicare ID - Type Unspecified