Healthcare Provider Details

I. General information

NPI: 1336362607
Provider Name (Legal Business Name): KATHRYN I STEWART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2234
  • Fax: 916-734-0415
Mailing address:
  • Phone: 916-734-2234
  • Fax: 916-734-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: