Provider Demographics
NPI:1447588546
Name:HEWETT, THOMAS J (LICSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:HEWETT
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 FARIBAULT CT
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4411
Mailing Address - Country:US
Mailing Address - Phone:952-233-3223
Mailing Address - Fax:
Practice Address - Street 1:1802 FARIBAULT CT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4411
Practice Address - Country:US
Practice Address - Phone:952-233-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical