Healthcare Provider Details

I. General information

NPI: 1144228321
Provider Name (Legal Business Name): SUSAN RENEE HEWITT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807-3618
US

IV. Provider business mailing address

DEPARTMENT 888182
KNOXVILLE TN
37995-0001
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3849
  • Fax: 865-992-5166
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW5692
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW4440
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: