MEDICARE: NICOLE STEWART M.S.W

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

General Provider Information

NPI Number	:	1750738803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE STEWART M.S.W

Provider Business Mailing Address
First Line	:	4601 FLAT ROCK RD
Second Line	:	UNIT 211
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 FLAT ROCK RD
Second Line	:	UNIT 211
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2027
Country	:	US
Telephone Number	:	516-652-6396
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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