MEDICARE: ELLIOTT EZELLE HEWETT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	092675-01	NY

General Provider Information

NPI Number	:	1497497598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIOTT EZELLE HEWETT LCSW

Provider Business Mailing Address
First Line	:	2548 RAYA WAY
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-5687
Country	:	US
Telephone Number	:	910-612-8636
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4444
Country	:	US
Telephone Number	:	201-365-4037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2022
Last Update Date	:	12/27/2025

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