Healthcare Provider Details

I. General information

NPI: 1245035716
Provider Name (Legal Business Name): HEATHER STEWART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MADISON AVE
COVINGTON KY
41011-1505
US

IV. Provider business mailing address

503 FARRELL DR
COVINGTON KY
41011-3775
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-3200
  • Fax: 859-534-2627
Mailing address:
  • Phone: 859-578-3200
  • Fax: 859-534-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2600057
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: