Healthcare Provider Details

I. General information

NPI: 1780369157
Provider Name (Legal Business Name): ANTONIA LEWIS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 EAGLEVIEW BLVD STE 120
EXTON PA
19341-1150
US

IV. Provider business mailing address

1500 CHESTNUT ST, PHILADELPHIA PA 19102 SUITE 2, #1169
PHILADELPHIA PA
19102
US

V. Phone/Fax

Practice location:
  • Phone: 610-422-3064
  • Fax: 484-870-9846
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023617
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: