Healthcare Provider Details

I. General information

NPI: 1063707099
Provider Name (Legal Business Name): JESSICA LEE LEWIS LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEE RIMER LCSW-R

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 SHERIDAN DR SUITE 500
AMHERST NY
14226-1727
US

IV. Provider business mailing address

3980 SHERIDAN DR SUITE 500
AMHERST NY
14226-1727
US

V. Phone/Fax

Practice location:
  • Phone: 716-558-5491
  • Fax:
Mailing address:
  • Phone: 716-558-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number078077
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: