MEDICARE: MR. DAVID HARKER 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	149014032	IL
2	1041C0700X	Clinical Social Worker	149.014032	IL

General Provider Information

NPI Number	:	1740517267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID HARKER LEWIS LCSW

Provider Business Mailing Address
First Line	:	1658 N MILWAUKEE AVE
Second Line	:	# 10014438
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:	312-219-4136
Fax Number	:

Provider Business Practice Location Address
First Line	:	1658 N MILWAUKEE AVE
Second Line	:	STE 10014438
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:	321-219-4136
Fax Number	:

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	05/08/2021

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