Healthcare Provider Details

I. General information

NPI: 1871370833
Provider Name (Legal Business Name): SAYWONZA NICOLE CUEVAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

15 FREEMAN PL
WEST ORANGE NJ
07052-4404
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone: 973-666-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06262800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: