Provider Demographics
NPI:1689805491
Name:STEWART, DAWN CHRISTINE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CHRISTINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6142 BARTRAM VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7710
Mailing Address - Country:US
Mailing Address - Phone:904-401-3097
Mailing Address - Fax:
Practice Address - Street 1:6142 BARTRAM VILLAGE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7710
Practice Address - Country:US
Practice Address - Phone:904-401-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 95361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002839900Medicaid