Provider Demographics
NPI:1891264719
Name:STEWART, SANDRA K (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 W RIVER RD N STE 300
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2788
Mailing Address - Country:US
Mailing Address - Phone:440-657-5658
Mailing Address - Fax:
Practice Address - Street 1:1530 W RIVER RD N
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2791
Practice Address - Country:US
Practice Address - Phone:440-212-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1500724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker