Provider Demographics
NPI:1780111914
Name:STEWART, CLAIRE R
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:R
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:R
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CATC II
Mailing Address - Street 1:7640 OSO AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-4704
Mailing Address - Country:US
Mailing Address - Phone:818-312-1328
Mailing Address - Fax:
Practice Address - Street 1:7640 OSO AVE APT 212
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-4704
Practice Address - Country:US
Practice Address - Phone:818-312-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168329I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty