Provider Demographics
NPI:1619208162
Name:JAN TEWES,LCSW,PLLC
Entity Type:Organization
Organization Name:JAN TEWES,LCSW,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:TEWES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-430-2173
Mailing Address - Street 1:132.5 ATWELL MILLS ANNEX
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035
Mailing Address - Country:US
Mailing Address - Phone:315-430-2173
Mailing Address - Fax:
Practice Address - Street 1:132.5 ATWELL MILLS ANNEX
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035
Practice Address - Country:US
Practice Address - Phone:315-430-2173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty