Provider Demographics
NPI:1902992688
Name:STEWART, MUFFY MARIE (PCC-S)
Entity Type:Individual
Prefix:MRS
First Name:MUFFY
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 38TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2062
Mailing Address - Country:US
Mailing Address - Phone:330-493-4528
Mailing Address - Fax:
Practice Address - Street 1:4368 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-433-1300
Practice Address - Fax:440-494-0828
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHE.0500365-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182217Medicaid