Healthcare Provider Details

I. General information

NPI: 1316852379
Provider Name (Legal Business Name): LAURA LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 34TH AVENUE DR W
BRADENTON FL
34205-1114
US

IV. Provider business mailing address

4212 34TH AVENUE DR W
BRADENTON FL
34205-1114
US

V. Phone/Fax

Practice location:
  • Phone: 312-860-0993
  • Fax:
Mailing address:
  • Phone: 312-860-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: