Provider Demographics
NPI:1619122058
Name:STEWART, VIRGILIO A (MSED)
Entity Type:Individual
Prefix:MR
First Name:VIRGILIO
Middle Name:A
Last Name:STEWART
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BLACKBERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3174
Mailing Address - Country:US
Mailing Address - Phone:631-484-5506
Mailing Address - Fax:
Practice Address - Street 1:10 BLACKBERRY HILL RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-3174
Practice Address - Country:US
Practice Address - Phone:631-484-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst