Provider Demographics
NPI:1518542083
Name:STEWART, DANIEL
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 S COAST HWY # 5521
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:909-998-8592
Mailing Address - Fax:
Practice Address - Street 1:2425 OLYMPIC BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4030
Practice Address - Country:US
Practice Address - Phone:909-998-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty