Provider Demographics
NPI:1588877625
Name:GEWIRTZ, ELLIOT (LCSW)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:GEWIRTZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 AYCRIGG AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4704
Mailing Address - Country:US
Mailing Address - Phone:973-460-4430
Mailing Address - Fax:
Practice Address - Street 1:228 AYCRIGG AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4704
Practice Address - Country:US
Practice Address - Phone:973-460-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013669001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical