Provider Demographics
NPI:1891975397
Name:STEWART, DAWN M (MS, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S GREER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3434
Mailing Address - Country:US
Mailing Address - Phone:901-849-6433
Mailing Address - Fax:
Practice Address - Street 1:214 S GREER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3434
Practice Address - Country:US
Practice Address - Phone:901-849-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBCBA #: 1-07-3269103TB0200X
TN0000000078103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509523Medicaid