Basic Information
| Provider Information | |||||||||
| NPI: | 1346375912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 VISTA WAY | ||||||||
| Address2: | SUITE 258 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607305900 | ||||||||
| FaxNumber: | 7607305911 | ||||||||
| Practice Location | |||||||||
| Address1: | 3605 VISTA WAY | ||||||||
| Address2: | SUITE 258 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607305900 | ||||||||
| FaxNumber: | 7607305911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 10890 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.