Healthcare Provider Details

I. General information

NPI: 1689106080
Provider Name (Legal Business Name): EMILY MARIE BEWLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MARIE AZZARA LCSW

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROCKFORD DR
NEWARK DE
19713-2120
US

IV. Provider business mailing address

100 ROCKFORD DR
NEWARK DE
19713-2120
US

V. Phone/Fax

Practice location:
  • Phone: 302-892-4485
  • Fax:
Mailing address:
  • Phone: 302-892-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018487
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001446
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: