Provider Demographics
NPI:1972580702
Name:ENTEL, LEWIS EUGENE (LCSW)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:EUGENE
Last Name:ENTEL
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 1:626 BEACH 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5202
Mailing Address - Country:US
Mailing Address - Phone:718-868-4959
Mailing Address - Fax:718-868-4959
Practice Address - Street 1:626 BEACH 8TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5202
Practice Address - Country:US
Practice Address - Phone:718-868-4959
Practice Address - Fax:718-868-4959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034456-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3164664OtherOXFORD HEALTH PLAN
NY159485POtherHIP HEALTH PLAN