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General NPI Number Information
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NPI Number | 1033430988
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Entity Type | Organization
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Legal Business Name | JANE E. LEWIS, PH.D. A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 10700 SANTA MONICA BLVD. SUITE 315
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-277-8810
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Fax | 310-374-7101
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Provider Business Mailing Address
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Address Line | 10700 SANTA MONICA BLVD. SUITE 315
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-277-8810
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Fax | 310-374-7101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANE ELIZABETH LEWIS
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Credential | PH.D.
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Telephone | 310-277-8810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY6555
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY6555
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License Number State | CA
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