Provider Demographics
NPI:1053499236
Name:STEWART, JEAN MARIE (MA PSYCHOLOGY C-4647)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY C-4647
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26511 CANCION DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5419
Mailing Address - Country:US
Mailing Address - Phone:949-246-5499
Mailing Address - Fax:
Practice Address - Street 1:30290 RANCHO VIEJO RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1565
Practice Address - Country:US
Practice Address - Phone:949-933-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health