Healthcare Provider Details

I. General information

NPI: 1508704933
Provider Name (Legal Business Name): MARY PAMELA LEWIS PPS, ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 PIEDRAS CIR
ALAMO CA
94507-2823
US

IV. Provider business mailing address

1871 PIEDRAS CIR
ALAMO CA
94507-2823
US

V. Phone/Fax

Practice location:
  • Phone: 925-413-9160
  • Fax:
Mailing address:
  • Phone: 925-413-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220103137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: