Healthcare Provider Details

I. General information

NPI: 1477031268
Provider Name (Legal Business Name): CHRISTINE STEWART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTY STEWART

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 W PETERSON AVE
CHICAGO IL
60659-4108
US

IV. Provider business mailing address

6301 N WESTERN AVE
CHICAGO IL
60659-2009
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-0300
  • Fax:
Mailing address:
  • Phone: 800-597-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025003
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: