Healthcare Provider Details

I. General information

NPI: 1558417600
Provider Name (Legal Business Name): NOELLE CELINE LYTWYN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SHREWSBURY AVE
SHREWSBURY NJ
07702-4134
US

IV. Provider business mailing address

8 IVY CT
MATAWAN NJ
07747-2914
US

V. Phone/Fax

Practice location:
  • Phone: 732-345-3400
  • Fax:
Mailing address:
  • Phone: 732-566-4761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: