Healthcare Provider Details

I. General information

NPI: 1992645964
Provider Name (Legal Business Name): XAVIER LAWRENCE LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7708 LITTLEFIELD CT
SEVERN MD
21144-1088
US

IV. Provider business mailing address

7708 LITTLEFIELD CT
SEVERN MD
21144-1088
US

V. Phone/Fax

Practice location:
  • Phone: 443-525-8298
  • Fax: 443-525-8298
Mailing address:
  • Phone: 443-525-8298
  • Fax: 443-525-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: