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General NPI Number Information
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NPI Number | 1184910754
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Entity Type | Individual
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Provider Name | MIRIAM STEWARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 14317 HICKORY DR
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City | PONCHATOULA
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State | LA
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Zip | 70454-6653
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Country | US
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Telephone | 985-974-8172
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 VICTORIA DR APT 2040
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City | BATON ROUGE
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State | LA
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Zip | 70805-7551
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Country | US
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Telephone | 225-284-4763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5363
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License Number State | LA
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