Provider Demographics
NPI:1558086579
Name:HEWLETT, TEAL (LCSW)
Entity Type:Individual
Prefix:
First Name:TEAL
Middle Name:
Last Name:HEWLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 TOWNEPARK WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2538
Mailing Address - Country:US
Mailing Address - Phone:859-333-7803
Mailing Address - Fax:
Practice Address - Street 1:102 DAVENTRY LN STE 3
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2869
Practice Address - Country:US
Practice Address - Phone:502-712-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2564881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical