Provider Demographics
NPI:1942420047
Name:STEWART, NANCY JILL (LMHC, ATR)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JILL
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3583
Mailing Address - Country:US
Mailing Address - Phone:508-498-1474
Mailing Address - Fax:
Practice Address - Street 1:445 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3749
Practice Address - Country:US
Practice Address - Phone:508-668-3283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health