Provider Demographics
NPI:1083042782
Name:LEWIS, ODELIND KING (LCSW)
Entity Type:Individual
Prefix:
First Name:ODELIND
Middle Name:KING
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ODELIND
Other - Middle Name:KING
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:120 THICKET CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1448
Mailing Address - Country:US
Mailing Address - Phone:732-942-1589
Mailing Address - Fax:
Practice Address - Street 1:321 NORTH WARREN STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-278-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055391001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical