Provider Demographics
NPI:1669535456
Name:STEWART, MARIA (PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 RIDGEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3930
Mailing Address - Country:US
Mailing Address - Phone:630-852-7336
Mailing Address - Fax:630-852-8177
Practice Address - Street 1:1047 S YORK RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5121
Practice Address - Country:US
Practice Address - Phone:630-852-7336
Practice Address - Fax:630-852-8177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005206103TC2200X
IL146001511235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04922024OtherBCBS PT
IL2222567OtherBCBS SP
IL313970Medicare ID - Type UnspecifiedMEDICARE