Provider Demographics
NPI:1609060342
Name:STEWART, MICHAEL D
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
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 1:434 MARIPOSA ST
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1541
Mailing Address - Country:US
Mailing Address - Phone:415-350-0635
Mailing Address - Fax:
Practice Address - Street 1:2800 VICENTE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2720
Practice Address - Country:US
Practice Address - Phone:415-661-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor