Healthcare Provider Details

I. General information

NPI: 1780049643
Provider Name (Legal Business Name): MONIQUE LYNETTE LEWIS LPC-S, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CHENANGO HILL DR
HAMILTON NY
13346-1257
US

IV. Provider business mailing address

515 CHENANGO HILL DR
HAMILTON NY
13346-1257
US

V. Phone/Fax

Practice location:
  • Phone: 540-598-4305
  • Fax:
Mailing address:
  • Phone: 504-598-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number014481
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5658
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: