Provider Demographics
NPI:1942364658
Name:STEWART, ROBERT PATRICK (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
Last Name:STEWART
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W OTTAWA RD
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-4090
Mailing Address - Country:US
Mailing Address - Phone:217-379-4302
Mailing Address - Fax:217-379-4304
Practice Address - Street 1:1510 W OTTAWA RD
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957-4090
Practice Address - Country:US
Practice Address - Phone:217-379-4302
Practice Address - Fax:217-379-4304
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0021831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-002183OtherLICENSED CLINICAL SOCIAL