Healthcare Provider Details

I. General information

NPI: 1164595468
Provider Name (Legal Business Name): LYNN LEBEDA CHURCHWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 GEORGES RD
DAYTON NJ
08810-1511
US

IV. Provider business mailing address

189 GEORGES RD
DAYTON NJ
08810-1511
US

V. Phone/Fax

Practice location:
  • Phone: 732-329-4550
  • Fax: 732-329-1609
Mailing address:
  • Phone: 732-329-4550
  • Fax: 732-329-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00144000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: