Provider Demographics
NPI:1437807005
Name:EUTSEY, TAYLOR A (LSW, LMSW)
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:A
Last Name:EUTSEY
Suffix:
Gender:F
Credentials:LSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 COLUMBUS AVE APT 10J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1435
Mailing Address - Country:US
Mailing Address - Phone:732-705-0063
Mailing Address - Fax:
Practice Address - Street 1:489 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3457
Practice Address - Country:US
Practice Address - Phone:551-349-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06551700104100000X
NY110723104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker