Healthcare Provider Details

I. General information

NPI: 1295309672
Provider Name (Legal Business Name): LAURA A LEWIS PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5861 GOODRICH RD APT 10C
CLARENCE CENTER NY
14032-9772
US

IV. Provider business mailing address

399 WILLOW GREEN DR
AMHERST NY
14228-3472
US

V. Phone/Fax

Practice location:
  • Phone: 716-566-8204
  • Fax:
Mailing address:
  • Phone: 716-566-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: