Provider Demographics
NPI:1962427062
Name:STEWART, SUSAN JOAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOAN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CENTRAL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2733
Mailing Address - Country:US
Mailing Address - Phone:814-678-6900
Mailing Address - Fax:814-678-6902
Practice Address - Street 1:19 CENTRAL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2733
Practice Address - Country:US
Practice Address - Phone:814-678-6900
Practice Address - Fax:814-678-6902
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161375OtherTRICARE
PA202626OtherUPMC
PA629608OtherBLUE SHIELD
PA201297000OtherMAGELLAN
PA042306ZDEJOtherMEDICARE PTAN
PA201297000OtherMAGELLAN
PA042306Medicare ID - Type UnspecifiedMEDICARE