MEDICARE: LAURIE K LEWIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW015276	PA

General Provider Information

NPI Number	:	1558416982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE K LEWIS LCSW

Provider Business Mailing Address
First Line	:	1108 MEWS LN
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2077
Country	:	US
Telephone Number	:	610-793-4673
Fax Number	:	610-793-2762

Provider Business Practice Location Address
First Line	:	1108 MEWS LN
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-2077
Country	:	US
Telephone Number	:	610-793-4673
Fax Number	:	610-793-2762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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