Healthcare Provider Details

I. General information

NPI: 1174651194
Provider Name (Legal Business Name): MARLO SHERRIE LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 TRYM ST
HAYWARD CA
94541-5430
US

IV. Provider business mailing address

1848 TRYM ST
FAIRVIEW CA
94541-5430
US

V. Phone/Fax

Practice location:
  • Phone: 510-305-9573
  • Fax:
Mailing address:
  • Phone: 510-305-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: