Provider Demographics
NPI:1558027342
Name:STEWART, CEZAR DEON (LCDCII161795)
Entity Type:Individual
Prefix:
First Name:CEZAR
Middle Name:DEON
Last Name:STEWART
Suffix:
Gender:M
Credentials:LCDCII161795
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1438
Mailing Address - Country:US
Mailing Address - Phone:330-379-3467
Mailing Address - Fax:330-379-3465
Practice Address - Street 1:665 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1438
Practice Address - Country:US
Practice Address - Phone:330-379-3467
Practice Address - Fax:330-379-3465
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161795101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0008762Medicaid