Provider Demographics
NPI:1902472889
Name:STEWART, RYAN B (MDIV, MA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:B
Last Name:STEWART
Suffix:
Gender:M
Credentials:MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 KASPER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1857
Mailing Address - Country:US
Mailing Address - Phone:919-323-6009
Mailing Address - Fax:
Practice Address - Street 1:4300 KASPER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1857
Practice Address - Country:US
Practice Address - Phone:919-323-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21085101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor