Provider Demographics
NPI:1396125753
Name:STEWART, WILLIE MAE (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:MAE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-1817
Mailing Address - Country:US
Mailing Address - Phone:516-297-6048
Mailing Address - Fax:631-920-2455
Practice Address - Street 1:1 PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-1817
Practice Address - Country:US
Practice Address - Phone:516-297-6048
Practice Address - Fax:631-920-2455
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical