Provider Demographics
NPI:1043039217
Name:STEWART, SAMUEL TYLER (BCBA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TYLER
Last Name:STEWART
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 ASHEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4338
Mailing Address - Country:US
Mailing Address - Phone:770-480-7263
Mailing Address - Fax:
Practice Address - Street 1:273 ASHEVILLE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4338
Practice Address - Country:US
Practice Address - Phone:770-480-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst