Provider Demographics
NPI:1427788827
Name:LEWIS, G'VON (LSW)
Entity type:Individual
Prefix:MS
First Name:G'VON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1211
Mailing Address - Country:US
Mailing Address - Phone:201-370-0603
Mailing Address - Fax:
Practice Address - Street 1:180 TICES LN STE 202
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1345
Practice Address - Country:US
Practice Address - Phone:732-354-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06778500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker