MEDICARE: WILLIE A. STEWART LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	104100000X	Social Worker	7153-C	NV

General Provider Information

NPI Number	:	1962645218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE A. STEWART LCSW

Provider Business Mailing Address
First Line	:	5135 CAMINO AL NORTE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2387
Country	:	US
Telephone Number	:	702-787-0166
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5343
Country	:	US
Telephone Number	:	702-787-0166
Fax Number	:	702-786-6911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	12/14/2023

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