Provider Demographics
NPI:1114425691
Name:STEWARD, NORVETTA NAOMI VICTORIA
Entity Type:Individual
Prefix:
First Name:NORVETTA
Middle Name:NAOMI VICTORIA
Last Name:STEWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 N GRATZ ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4125
Mailing Address - Country:US
Mailing Address - Phone:267-928-7304
Mailing Address - Fax:
Practice Address - Street 1:1524 N GRATZ ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4125
Practice Address - Country:US
Practice Address - Phone:267-928-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities