Provider Demographics
NPI:1225351448
Name:STEWART, RON K
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:K
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4309
Mailing Address - Country:US
Mailing Address - Phone:516-816-8766
Mailing Address - Fax:
Practice Address - Street 1:106 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4309
Practice Address - Country:US
Practice Address - Phone:516-816-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist