Healthcare Provider Details

I. General information

NPI: 1396286464
Provider Name (Legal Business Name): PETER LEWIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S MAIN ST
CULPEPER VA
22701-3210
US

IV. Provider business mailing address

PO BOX 21975
BELFAST ME
04915-4116
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-4557
  • Fax: 540-825-4566
Mailing address:
  • Phone: 540-321-4281
  • Fax: 540-321-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010651
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: