Provider Demographics
NPI:1417338906
Name:ATWELL, EMILY (DSW, LCSW, LMFT)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:ATWELL
Suffix:
Gender:F
Credentials:DSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MORGAN ST
Mailing Address - Street 2:APT 3202
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6237
Mailing Address - Country:US
Mailing Address - Phone:215-262-2731
Mailing Address - Fax:
Practice Address - Street 1:34 E PUTNAM AVE STE 121
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5442
Practice Address - Country:US
Practice Address - Phone:212-847-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0185691041C0700X
NY001308106H00000X
CT103411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE232833266OtherAETNA