Healthcare Provider Details

I. General information

NPI: 1174180400
Provider Name (Legal Business Name): MRS. AMY LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CONGRESS ST STE 2
SALEM MA
01970-5567
US

IV. Provider business mailing address

90 POPLAR ST
DANVERS MA
01923-2453
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-4274
  • Fax:
Mailing address:
  • Phone: 978-978-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN280220
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: