Healthcare Provider Details

I. General information

NPI: 1780818393
Provider Name (Legal Business Name): TRENAYE LYNETTE LEWIS-SUTTON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 S DADELAND BLVD STE 1500
MIAMI FL
33156-7816
US

IV. Provider business mailing address

9100 S DADELAND BLVD STE 1500
MIAMI FL
33156-7816
US

V. Phone/Fax

Practice location:
  • Phone: 415-424-4266
  • Fax: 415-520-6633
Mailing address:
  • Phone: 415-424-4266
  • Fax: 415-520-6633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10113-C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9533
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: