Healthcare Provider Details

I. General information

NPI: 1932114782
Provider Name (Legal Business Name): LEWIS NEMES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/15/2021
Certification Date: 08/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BARLANE PL NW
ALBUQUERQUE NM
87107-5402
US

IV. Provider business mailing address

516 BARLANE PL NW
ALBUQUERQUE NM
87107-5402
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-6616
  • Fax: 505-765-9010
Mailing address:
  • Phone: 505-345-6616
  • Fax: 505-765-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number523
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: