MEDICARE: KATHERINE ELLEN STEWART MHC-LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor	110689-01	NY

General Provider Information

NPI Number	:	1356967533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELLEN STEWART MHC-LP

Provider Business Mailing Address
First Line	:	459 COLUMBUS AVE STE 124
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5129
Country	:	US
Telephone Number	:	866-525-2766
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 COLUMBUS AVE STE 124
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5129
Country	:	US
Telephone Number	:	866-525-2766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	12/08/2022

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