Provider Demographics
NPI:1346566742
Name:STEWART, JENNIFER ANN (MSW, ACSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW, ACSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1459
Mailing Address - Country:US
Mailing Address - Phone:802-388-6751
Mailing Address - Fax:802-388-3108
Practice Address - Street 1:109 CATAMOUNT PARK
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1459
Practice Address - Country:US
Practice Address - Phone:802-388-6451
Practice Address - Fax:802-388-3108
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00641151041C0700X
VT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017521Medicaid