Healthcare Provider Details

I. General information

NPI: 1831128263
Provider Name (Legal Business Name): LISA M. LEWIS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9268 MADISON AVE
ORANGEVALE CA
95662-5858
US

IV. Provider business mailing address

9268 MADISON AVE
ORANGEVALE CA
95662-5858
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-1100
  • Fax: 916-966-3995
Mailing address:
  • Phone: 916-988-1100
  • Fax: 916-966-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS11353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: