Provider Demographics
NPI:1659495851
Name:STEWART, WENDY ANN (LCSW, ABD)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW, ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1713
Mailing Address - Country:US
Mailing Address - Phone:201-953-3039
Mailing Address - Fax:
Practice Address - Street 1:103 PARK ST STE 4
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2935
Practice Address - Country:US
Practice Address - Phone:201-953-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043087001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01673612Medicaid
NJ184604000Medicare UPIN