Healthcare Provider Details

I. General information

NPI: 1558027342
Provider Name (Legal Business Name): CEZAR DEON STEWART LICDC.163053
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MONTROSE WEST AVE
COPLEY OH
44321-3121
US

IV. Provider business mailing address

2643 ELMWOOD ST
CUYAHOGA FALLS OH
44221-2608
US

V. Phone/Fax

Practice location:
  • Phone: 330-933-4649
  • Fax:
Mailing address:
  • Phone: 330-705-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.163053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: