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General NPI Number Information
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NPI Number | 1104138239
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Entity Type | Individual
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Provider Name | CHARLENE TRAVIESO LEWIS LCSW,CAP,CST
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Gender | Female
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 7344 SW 48TH ST
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City | MIAMI
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State | FL
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Zip | 33155-5546
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Country | US
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Telephone | 786-290-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 8440 SW 21ST ST
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City | MIAMI
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State | FL
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Zip | 33155-1029
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Country | US
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Telephone | 786-290-0935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP-4255
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9306
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License Number State | FL
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