Provider Demographics
NPI:1699440123
Name:HEWITT, SHAYON BONIQUE (LMSW)
Entity type:Individual
Prefix:
First Name:SHAYON
Middle Name:BONIQUE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DELL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1062
Mailing Address - Country:US
Mailing Address - Phone:914-564-7096
Mailing Address - Fax:
Practice Address - Street 1:10 DELL AVE STE 202
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1062
Practice Address - Country:US
Practice Address - Phone:914-564-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1564451103K00000X, 103TC1900X, 104100000X
NY1699440123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling