MEDICARE: DR. SARAH LEWIS-LEVY PHD

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	103T00000X	Psychologist	019769	NY

General Provider Information

NPI Number	:	1770820219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH LEWIS-LEVY PHD

Provider Business Mailing Address
First Line	:	1468 LACHONA CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 LACHONA CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3411
Country	:	US
Telephone Number	:	917-224-1352
Fax Number	:

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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