MEDICARE: MR. JOSEPH LEITH ANTHONY LEWIS RBT

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558911883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH LEITH ANTHONY LEWIS RBT

Provider Business Mailing Address
First Line	:	1510 WINDWOOD DR NE APT 103
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-7592
Country	:	US
Telephone Number	:	321-720-5941
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N TROPICAL TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4737
Country	:	US
Telephone Number	:	321-961-7831
Fax Number	:	407-960-3009

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

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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