Provider Demographics
NPI:1790846939
Name:TEWES, JAN B (MSW)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:B
Last Name:TEWES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:ATWELL MILLS ANNEX
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-0046
Mailing Address - Country:US
Mailing Address - Phone:315-430-2173
Mailing Address - Fax:315-655-2191
Practice Address - Street 1:3258 ROUTE 20
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-8408
Practice Address - Country:US
Practice Address - Phone:315-430-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0509041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD4939Medicare PIN