Provider Demographics
NPI:1952534406
Name:STEWART, KATHLEEN DENISE (MSW, LISW-S)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DENISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:K.
Other - Middle Name:DENISE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LISW-S
Mailing Address - Street 1:1136 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-4112
Mailing Address - Country:US
Mailing Address - Phone:937-254-6700
Mailing Address - Fax:937-254-6776
Practice Address - Street 1:1136 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-4112
Practice Address - Country:US
Practice Address - Phone:937-254-6700
Practice Address - Fax:937-254-6776
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.5755.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical