Provider Demographics
NPI:1740565183
Name:STEWART, MARLYNA ROSELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARLYNA
Middle Name:ROSELLA
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1926
Mailing Address - Country:US
Mailing Address - Phone:415-309-8722
Mailing Address - Fax:
Practice Address - Street 1:518 BYRON ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2006
Practice Address - Country:US
Practice Address - Phone:415-309-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 267221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical