Provider Demographics
NPI:1821147935
Name:STEWART, DOREEN (PHD, CMHC)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHD, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2527 GLEBE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3109
Mailing Address - Country:US
Mailing Address - Phone:718-904-4400
Mailing Address - Fax:718-931-7307
Practice Address - Street 1:1967 TURNBULL AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2519
Practice Address - Country:US
Practice Address - Phone:718-842-1400
Practice Address - Fax:718-792-2427
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X
NY002718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral