Provider Demographics
NPI:1528106374
Name:STEWART, DEBRA J
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13585 SAN PABLO AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3863
Mailing Address - Country:US
Mailing Address - Phone:510-942-4700
Mailing Address - Fax:510-942-4776
Practice Address - Street 1:13585 SAN PABLO AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3863
Practice Address - Country:US
Practice Address - Phone:510-942-4700
Practice Address - Fax:510-942-4776
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC1950400OtherDR. LIC.