Healthcare Provider Details

I. General information

NPI: 1710895263
Provider Name (Legal Business Name): MAKEBA N EARTH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MORRIS AVE STE 101
SPRINGFIELD NJ
07081-1224
US

IV. Provider business mailing address

42 TYLER ST
PATERSON NJ
07501-1044
US

V. Phone/Fax

Practice location:
  • Phone: 973-323-9225
  • Fax:
Mailing address:
  • Phone: 973-807-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: