Provider Demographics
NPI:1740723667
Name:STEWART, DOMINICK (LMSW)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 PROCTOR BLVD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6119
Mailing Address - Country:US
Mailing Address - Phone:315-790-5447
Mailing Address - Fax:
Practice Address - Street 1:158 PROCTOR BLVD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6119
Practice Address - Country:US
Practice Address - Phone:315-790-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087193104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker