Provider Demographics
NPI:1649657081
Name:AMY STEWART
Entity type:Organization
Organization Name:AMY STEWART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:727-278-2479
Mailing Address - Street 1:4903 CINNABAR WAY
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5374
Mailing Address - Country:US
Mailing Address - Phone:727-278-2479
Mailing Address - Fax:
Practice Address - Street 1:4903 CINNABAR WAY
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5374
Practice Address - Country:US
Practice Address - Phone:727-278-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health