Healthcare Provider Details

I. General information

NPI: 1528283405
Provider Name (Legal Business Name): VIVIENNE M STEWART LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SPRUCE ST SUITE 205
TRENTON NJ
08638-3957
US

IV. Provider business mailing address

610 DELFT LN
HATBORO PA
19040-4504
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-6788
  • Fax: 609-989-1245
Mailing address:
  • Phone: 609-396-6788
  • Fax: 609-989-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00348100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: