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General NPI Number Information
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NPI Number | 1275012312
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Entity Type | Organization
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Legal Business Name | LEWIN PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 839 ELKRIDGE LANDING RD STE 211
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City | LINTHICUM
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State | MD
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Zip | 21090-2946
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Country | US
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Telephone | 410-703-6784
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Fax | 866-858-1828
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Provider Business Mailing Address
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Address Line | 839 ELKRIDGE LANDING RD STE 211
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City | LINTHICUM
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State | MD
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Zip | 21090-2946
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Country | US
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Telephone | 410-703-6784
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Fax | 866-858-1828
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLINTON JARED LEWIN
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Credential | PSYD
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Telephone | 410-703-6784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 05951
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License Number State | MD
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