Provider Demographics
NPI:1306813985
Name:STEWART, CHRISTINE RICHARDS (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RICHARDS
Last Name:STEWART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 6922
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-6922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 TWIN RIVER RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-5033
Practice Address - Country:US
Practice Address - Phone:508-454-7770
Practice Address - Fax:401-354-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016101041C0700X, 101YM0800X
MA1120931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27656-0OtherRI BLUE CROSS BLUE SHIELD
RI411933OtherBLUE CHIP
RI007009381Medicare ID - Type Unspecified