Provider Demographics
NPI:1215047873
Name:STEWART, VIRGINIA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:15 NORTH ELLSWORTH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-579-5900
Mailing Address - Fax:650-363-0436
Practice Address - Street 1:15 NORTH ELLSWORTH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-579-5900
Practice Address - Fax:650-363-0436
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW56521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical