1275144602 NPI number — Synthia Elaina Stewart Licensed Clinical Social Worker

Table of content: Synthia Elaina Stewart Licensed Clinical Social Worker (NPI 1275144602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275144602 NPI number — Synthia Elaina Stewart Licensed Clinical Social Worker

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
Stewart
Provider First Name:
Synthia
Provider Middle Name:
Elaina
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Licensed Clinical Social Worker
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Psychotherapist
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275144602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
Venus
Provider Business Mailing Address State Name:
Texas
Provider Business Mailing Address Postal Code:
76084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
8176883229
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
Venus
Provider Business Practice Location Address State Name:
Texas
Provider Business Practice Location Address Postal Code:
76084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
8176883229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  59738 , registered in the state of Texas ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904010883 , registered in the state of Virginia ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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