Healthcare Provider Details

I. General information

NPI: 1356168926
Provider Name (Legal Business Name): LIAM KERWIN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BRIDGE PLAZA DR
MANALAPAN NJ
07726-1700
US

IV. Provider business mailing address

44 DEERFIELD RD
WAYNE NJ
07470-6414
US

V. Phone/Fax

Practice location:
  • Phone: 732-648-6423
  • Fax:
Mailing address:
  • Phone: 973-809-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07179200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: