Healthcare Provider Details

I. General information

NPI: 1053724823
Provider Name (Legal Business Name): ELIZABETH M MAC EWEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M SCHMIDT LCSW

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 BLOOMFIELD AVE SUITE 300, 3RD FLOOR
VERONA NJ
07044-1367
US

IV. Provider business mailing address

799 BLOOMFIELD AVE SUITE 300, 3RD FLOOR
VERONA NJ
07044-1367
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-6130
  • Fax:
Mailing address:
  • Phone: 973-429-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05727300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05589400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: