Healthcare Provider Details

I. General information

NPI: 1639888449
Provider Name (Legal Business Name): CHARLOTTE MARIE LEWIS CES, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 POST ST
BOONVILLE NY
13309-1235
US

IV. Provider business mailing address

406 POST ST STE B
BOONVILLE NY
13309-1235
US

V. Phone/Fax

Practice location:
  • Phone: 315-982-0433
  • Fax: 315-358-4399
Mailing address:
  • Phone: 315-807-8670
  • Fax: 315-222-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014535-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: