Provider Demographics
NPI:1316289473
Name:STEWART, CHRISTOPHER ROBERT (LICSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:STEWART
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2710
Mailing Address - Country:US
Mailing Address - Phone:207-712-4402
Mailing Address - Fax:
Practice Address - Street 1:144 FORE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4843
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-771-3578
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05751200104100000X
MA1194041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker