Provider Demographics
NPI:1649399437
Name:STEWART, MARILYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 W NEES AVE
Mailing Address - Street 2:#247
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6153
Mailing Address - Country:US
Mailing Address - Phone:770-330-3323
Mailing Address - Fax:
Practice Address - Street 1:1470 W HERNDON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0552
Practice Address - Country:US
Practice Address - Phone:559-256-2000
Practice Address - Fax:559-256-3000
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20912103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist