Provider Demographics
NPI:1720804255
Name:SEWNATH, MAITRY
Entity type:Individual
Prefix:
First Name:MAITRY
Middle Name:
Last Name:SEWNATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 VALLEY RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:STIRLING
Mailing Address - State:NJ
Mailing Address - Zip Code:07980-1346
Mailing Address - Country:US
Mailing Address - Phone:908-809-9463
Mailing Address - Fax:
Practice Address - Street 1:1390 VALLEY RD STE 1D
Practice Address - Street 2:
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980-1346
Practice Address - Country:US
Practice Address - Phone:908-809-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00747800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional