Provider Demographics
NPI:1003457870
Name:HEWITT, LOGAN (LMSW LGSM)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:LMSW LGSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6703 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1705
Mailing Address - Country:US
Mailing Address - Phone:301-820-1720
Mailing Address - Fax:
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-826-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2021-11-24
Deactivation Date:2021-10-11
Deactivation Code:
Reactivation Date:2021-11-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker