Provider Demographics
NPI:1366594871
Name:STEWART, KENNETH B (MSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
Last Name:STEWART
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 AUBURN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1831
Mailing Address - Country:US
Mailing Address - Phone:916-483-2154
Mailing Address - Fax:916-483-2850
Practice Address - Street 1:3000 AUBURN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1831
Practice Address - Country:US
Practice Address - Phone:916-483-2154
Practice Address - Fax:916-483-2850
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS284541041C0700X
UT137036-35011041C0700X
MI68010797481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical