Provider Demographics
NPI:1215750054
Name:LOUIS, DARRYL (LSW)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N OLDEN AVENUE EXT STE 29
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-2111
Mailing Address - Country:US
Mailing Address - Phone:609-237-7100
Mailing Address - Fax:609-616-7904
Practice Address - Street 1:1901 N OLDEN AVENUE EXT STE 29
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2111
Practice Address - Country:US
Practice Address - Phone:609-237-7100
Practice Address - Fax:609-616-7904
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06246700104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker