Provider Demographics
NPI:1497497598
Name:HEWETT, ELLIOTT EZELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:EZELLE
Last Name:HEWETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 RAYA WAY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5687
Mailing Address - Country:US
Mailing Address - Phone:910-612-8636
Mailing Address - Fax:
Practice Address - Street 1:2050 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4002
Practice Address - Country:US
Practice Address - Phone:718-483-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092675-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical