Provider Demographics
NPI:1346262706
Name:STEWART, ROBERT W (EDD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:STEWART
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 W 20TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3033
Mailing Address - Country:US
Mailing Address - Phone:970-353-2000
Mailing Address - Fax:970-356-4827
Practice Address - Street 1:8217 W 20TH ST
Practice Address - Street 2:STE A
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3033
Practice Address - Country:US
Practice Address - Phone:970-353-2000
Practice Address - Fax:970-356-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30804078Medicaid
CO643344OtherBLUE CROSS NUMBER
CO559874OtherVALUE OPTIONS PROVIDER NO
CO559874OtherVALUE OPTIONS PROVIDER NO