Provider Demographics
NPI:1982348819
Name:STEWART, SAM
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 MING AVE APT E14
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4669
Mailing Address - Country:US
Mailing Address - Phone:661-436-4047
Mailing Address - Fax:
Practice Address - Street 1:5558 CALIFORNIA AVE STE 340
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0710
Practice Address - Country:US
Practice Address - Phone:661-326-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician