MEDICARE: CAROLYN G STEWART LCSW

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	104100000X	Social Worker	LCSW0655	AZ

General Provider Information

NPI Number	:	1598748378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN G STEWART LCSW

Provider Business Mailing Address
First Line	:	650 W SUNLIGHT LN
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5430
Country	:	US
Telephone Number	:	520-498-5089
Fax Number	:	520-498-5232

Provider Business Practice Location Address
First Line	:	2262 W MAGEE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-4329
Country	:	US
Telephone Number	:	520-498-5089
Fax Number	:	520-498-5232

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	10/25/2007

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