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NPI Code Detail

MEDICARE: LISA MATOS'LEWIS

MEDICARE: LISA MATOS'LEWIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1063622843
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MATOS'LEWIS
Provider Business Mailing Address
First Line : 751 WASHINGTON ST APT 7
Second Line :
City : DORCHESTER CENTER
State : MA
Zip : 02124-4435
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 317 BLUE HILL AVE
Second Line :
City : DORCHESTER
State : MA
Zip : 02121-4302
Country : US
Telephone Number : 617-427-4470
Fax Number : 617-442-9419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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Directions to “ LISA MATOS'LEWIS ” Practice Location

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