=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184837536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYLLIS K. STEWART, LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 01/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15300 VENTURA BLVD SUITE 525
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-789-7728
-----------------------------------------------------
Fax | 323-466-0547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15300 VENTURA BLVD SUITE 525
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-3103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-789-7728
-----------------------------------------------------
Fax | 323-466-0547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PHYLLIS K STEWART
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 818-789-7728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS05270
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------