Provider Demographics
NPI:1184856114
Name:STEWART, ROGER KEITH (LCSW, PIP)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:KEITH
Last Name:STEWART
Suffix:
Gender:M
Credentials:LCSW, PIP
Other - Prefix:MR
Other - First Name:R
Other - Middle Name:KEITH
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, PIP
Mailing Address - Street 1:PO BOX 1863
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1863
Mailing Address - Country:US
Mailing Address - Phone:251-928-0702
Mailing Address - Fax:
Practice Address - Street 1:909 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2985
Practice Address - Country:US
Practice Address - Phone:251-928-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0722-1865C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical