Healthcare Provider Details

I. General information

NPI: 1649399437
Provider Name (Legal Business Name): MARILYN STEWART PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 W HERNDON AVE SUITE 300
FRESNO CA
93711-0552
US

IV. Provider business mailing address

373 W NEES AVE #247
FRESNO CA
93711-6153
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-2000
  • Fax: 559-256-3000
Mailing address:
  • Phone: 770-330-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY20912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: