Healthcare Provider Details

I. General information

NPI: 1184329682
Provider Name (Legal Business Name): LEWES MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24160 PORT LN UNIT 309
LEWES DE
19958-4259
US

IV. Provider business mailing address

24160 PORT LN UNIT 309
LEWES DE
19958-4259
US

V. Phone/Fax

Practice location:
  • Phone: 860-604-8469
  • Fax:
Mailing address:
  • Phone: 860-601-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN BYRNE
Title or Position: MANAGING MEMBER/OWNER
Credential: LCSW
Phone: 860-604-8469