=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790700011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERMAINE MARIE LEWIS MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9800 BUCCANEER MALL STE 8
-----------------------------------------------------
City | ST THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00802-2402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-774-5017
-----------------------------------------------------
Fax | 340-774-5384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 305165
-----------------------------------------------------
City | ST THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00803-5165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-774-5017
-----------------------------------------------------
Fax | 340-774-5384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1-2017972-2006
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------