Provider Demographics
NPI:1144600404
Name:STEWART, ANTONIA MARIE
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:MARIE
Last Name:STEWART
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 1:17 IONIA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-2519
Mailing Address - Country:US
Mailing Address - Phone:413-732-3069
Mailing Address - Fax:413-732-0223
Practice Address - Street 1:755 WORTHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1140
Practice Address - Country:US
Practice Address - Phone:413-732-3069
Practice Address - Fax:413-732-0223
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator