Provider Demographics
NPI:1881435709
Name:STEWART, LISA M (MSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BRANCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 SUSAN CONSTANT DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2659
Mailing Address - Country:US
Mailing Address - Phone:757-310-3535
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-2659
Practice Address - Country:US
Practice Address - Phone:757-310-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0732010818OtherQMHP-A