Provider Demographics
NPI:1154849180
Name:ELIZABETH MAC EWEN LCSW LLC
Entity Type:Organization
Organization Name:ELIZABETH MAC EWEN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARYEL
Authorized Official - Last Name:MAC EWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-903-1183
Mailing Address - Street 1:5 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2714
Mailing Address - Country:US
Mailing Address - Phone:973-903-1183
Mailing Address - Fax:
Practice Address - Street 1:13 JAMES ST FL 1
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5941
Practice Address - Country:US
Practice Address - Phone:973-903-1183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05589400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1053724823OtherNPI 1