Provider Demographics
NPI:1235893538
Name:STEWART, MADISON JEAN
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JEAN
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 1:1602 SUMMIT POINTE APT 1602
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1035
Mailing Address - Country:US
Mailing Address - Phone:570-878-8092
Mailing Address - Fax:
Practice Address - Street 1:4113 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1301
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician