Healthcare Provider Details

I. General information

NPI: 1831206317
Provider Name (Legal Business Name): CYNTHIA LEWIN L.C.A.D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOND ST
ASBURY PARK NJ
07712-5939
US

IV. Provider business mailing address

119 MOUNT HERMON WAY
OCEAN GROVE NJ
07756-1443
US

V. Phone/Fax

Practice location:
  • Phone: 732-869-2773
  • Fax:
Mailing address:
  • Phone: 732-776-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00035800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: