Provider Demographics
NPI:1285784553
Name:STEWARD, THOMAS S (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:S
Last Name:STEWARD
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 1:62 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:WHITE ROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87547-3400
Mailing Address - Country:US
Mailing Address - Phone:505-412-0010
Mailing Address - Fax:
Practice Address - Street 1:3250 TRINITY DR STE C
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2226
Practice Address - Country:US
Practice Address - Phone:505-412-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-33791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33470707Medicaid