Provider Demographics
NPI:1215103973
Name:STEWART, THOMAS C (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:STEWART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 92ND ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1688
Mailing Address - Country:US
Mailing Address - Phone:347-804-4469
Mailing Address - Fax:
Practice Address - Street 1:115 E 92ND ST
Practice Address - Street 2:STE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1688
Practice Address - Country:US
Practice Address - Phone:347-804-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0790991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical