Provider Demographics
NPI:1225439474
Name:STEWART, CRYSTAL TAMARA (BSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:TAMARA
Last Name:STEWART
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:TAMARA
Other - Last Name:PETROSSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 ESSEX PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1543
Mailing Address - Country:US
Mailing Address - Phone:407-860-8664
Mailing Address - Fax:
Practice Address - Street 1:914 ESSEX PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1543
Practice Address - Country:US
Practice Address - Phone:407-860-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker