Provider Demographics
NPI:1669407094
Name:STEWART, LAUREL (MSW)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2922
Mailing Address - Country:US
Mailing Address - Phone:860-683-2823
Mailing Address - Fax:413-567-8724
Practice Address - Street 1:34 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2922
Practice Address - Country:US
Practice Address - Phone:860-683-2823
Practice Address - Fax:413-567-8724
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLCSW 0005461041C0700X
MALICSW 1016031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical