Healthcare Provider Details

I. General information

NPI: 1881186088
Provider Name (Legal Business Name): JUDY LAURA LEWIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE
NEW YORK NY
10029-2196
US

IV. Provider business mailing address

1512 NEW YORK AVE APT 2
BROOKLYN NY
11210-2755
US

V. Phone/Fax

Practice location:
  • Phone: 646-545-5207
  • Fax: 212-828-6145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: