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General NPI Number Information
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NPI Number | 1578902680
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Entity Type | Individual
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Provider Name | MARRY JEAN STUART
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Gender | Female
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 39959 SIERRA HWY STE 150
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City | PALMDALE
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State | CA
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Zip | 93550-3320
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Country | US
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Telephone | 213-332-5547
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Fax |
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Provider Business Mailing Address
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Address Line | 14812 NOKOMIS RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-4809
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Country | US
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Telephone | 760-912-2055
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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 | LCSW77991
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License Number State | CA
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