Healthcare Provider Details

I. General information

NPI: 1982265195
Provider Name (Legal Business Name): DIANA STEWART LSCW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 14
TIMONIUM MD
21093-6211
US

IV. Provider business mailing address

939 CHESTNUT ST
HAGERSTOWN MD
21740-6306
US

V. Phone/Fax

Practice location:
  • Phone: 855-573-4313
  • Fax:
Mailing address:
  • Phone: 240-313-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: