Provider Demographics
NPI:1679760201
Name:LYNN LEBEDA CHURCHWELL
Entity type:Organization
Organization Name:LYNN LEBEDA CHURCHWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHURCHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-329-4550
Mailing Address - Street 1:189 GEORGES RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1511
Mailing Address - Country:US
Mailing Address - Phone:732-329-4550
Mailing Address - Fax:732-329-1609
Practice Address - Street 1:189 GEORGES RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1511
Practice Address - Country:US
Practice Address - Phone:732-329-4550
Practice Address - Fax:732-329-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098459Medicare PIN
NJY50609Medicare UPIN