Provider Demographics
NPI:1477743573
Name:STEWART, CAROLINE RIDOUT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:RIDOUT
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:CUMBERLAND
Other - Last Name:RIDOUT-STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1527 W LEWIS ST
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1220
Mailing Address - Country:US
Mailing Address - Phone:619-491-0080
Mailing Address - Fax:619-296-1863
Practice Address - Street 1:1527 W LEWIS ST
Practice Address - Street 2:STE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1220
Practice Address - Country:US
Practice Address - Phone:619-491-0080
Practice Address - Fax:619-296-1863
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS141731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1021795OtherCIGNA
11655002OtherCAQH