Provider Demographics
NPI:1912187998
Name:LOVELL, CHERYL WASHINGTON (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:WASHINGTON
Last Name:LOVELL
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:WASHINGTON
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3594 EAST TREMONT AVENUE
Mailing Address - Street 2:ROOM 210
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:718-792-4178
Mailing Address - Fax:718-792-2496
Practice Address - Street 1:3594 EAST TREMONT AVENUE
Practice Address - Street 2:ROOM 210
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:718-792-4178
Practice Address - Fax:718-792-2496
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0749481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical