Provider Demographics
NPI:1639878283
Name:HEWITT, TIMOTHY JOHN (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:HEWITT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:JOHN
Other - Last Name:PETTUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:40 ORCHARD RD APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2187
Mailing Address - Country:US
Mailing Address - Phone:860-885-4745
Mailing Address - Fax:
Practice Address - Street 1:40 ORCHARD RD APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-2187
Practice Address - Country:US
Practice Address - Phone:860-885-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical