Provider Demographics
NPI:1316303662
Name:STEWART, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1029 N BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-1518
Mailing Address - Country:US
Mailing Address - Phone:818-209-6693
Mailing Address - Fax:818-859-7125
Practice Address - Street 1:1029 N BRIGHTON ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1518
Practice Address - Country:US
Practice Address - Phone:818-209-6693
Practice Address - Fax:818-859-7125
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW287031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical