Provider Demographics
NPI:1336348036
Name:STEWART, MARJORIE (MH-18289)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MH-18289
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S BEDFORD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5145
Mailing Address - Country:US
Mailing Address - Phone:617-982-0181
Mailing Address - Fax:
Practice Address - Street 1:2216 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3860
Practice Address - Country:US
Practice Address - Phone:613-982-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-18289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK13708400Medicaid
AK684962OtherMEDICARE