Healthcare Provider Details

I. General information

NPI: 1982936415
Provider Name (Legal Business Name): DOROTHY OTNOW LEWIS I M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 YORK ST
NEW HAVEN CT
06511-5620
US

IV. Provider business mailing address

10 SAINT RONAN TER
NEW HAVEN CT
06511-2315
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-3933
  • Fax: 203-752-1807
Mailing address:
  • Phone: 203-776-4265
  • Fax: 203-752-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12319
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: