Healthcare Provider Details

I. General information

NPI: 1679760201
Provider Name (Legal Business Name): LYNN LEBEDA CHURCHWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
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 Number
License Number State

VIII. Authorized Official

Name: LYNN L CHURCHWELL
Title or Position: OWNER
Credential: LCSW
Phone: 732-329-4550