MEDICARE: KENNETH B. STEWART MSW

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	1041C0700X	Clinical Social Worker	LCS28454	CA
2	1041C0700X	Clinical Social Worker	137036-3501	UT
3	1041C0700X	Clinical Social Worker	6801079748	MI

General Provider Information

NPI Number	:	1366594871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH B. STEWART MSW

Provider Business Mailing Address
First Line	:	3000 AUBURN BLVD
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1831
Country	:	US
Telephone Number	:	916-483-2154
Fax Number	:	916-483-2850

Provider Business Practice Location Address
First Line	:	3000 AUBURN BLVD
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-1831
Country	:	US
Telephone Number	:	916-483-2154
Fax Number	:	916-483-2850

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	10/29/2014

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