Healthcare Provider Details

I. General information

NPI: 1477414241
Provider Name (Legal Business Name): SUSANNA LEWIS LCSW-C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVENUE FLOOR 5 #35
TOWSON MD
21204
US

IV. Provider business mailing address

113 DEEPDENE RD
BALTIMORE MD
21210-1911
US

V. Phone/Fax

Practice location:
  • Phone: 443-454-5787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUSANNA REBECCA LEWIS
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW-C
Phone: 443-454-5787