Healthcare Provider Details

I. General information

NPI: 1144386269
Provider Name (Legal Business Name): NONA LEWIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 COOL TIMBER RD
GHENT NY
12075-1245
US

IV. Provider business mailing address

72 COOL TIMBER RD
GHENT NY
12075-1245
US

V. Phone/Fax

Practice location:
  • Phone: 518-672-4537
  • Fax: 518-672-4537
Mailing address:
  • Phone: 518-672-4537
  • Fax: 518-672-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: