Provider Demographics
NPI:1922024918
Name:STEWART, CHRISTINE LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:LOUISE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-0390
Mailing Address - Country:US
Mailing Address - Phone:317-718-0044
Mailing Address - Fax:317-745-5219
Practice Address - Street 1:7 MANOR DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9400
Practice Address - Country:US
Practice Address - Phone:317-718-0044
Practice Address - Fax:317-745-5219
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34100083A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
270168OtherMHN
7992006OtherAETNA
000000176499OtherANTHEM BCBS
11559642OtherCAQH
IN200225810AMedicaid
222655000OtherMAGELLAN
IN000000678921OtherANTHEM GROUP
270168OtherMHN