Healthcare Provider Details

I. General information

NPI: 1811832843
Provider Name (Legal Business Name): RENEE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BEACH 20TH ST
FAR ROCKAWAY NY
11691-3502
US

IV. Provider business mailing address

1185 MORRIS AVE APT 2G
BRONX NY
10456-4730
US

V. Phone/Fax

Practice location:
  • Phone: 718-327-7163
  • Fax:
Mailing address:
  • Phone: 929-764-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: