MEDICARE: MS. MARYLYNN-MIMI LEWIS MSW, LCSW, CADCII

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
1	1041C0700X	Clinical Social Worker	LCS 20427	CA

General Provider Information

NPI Number	:	1073633210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARYLYNN-MIMI LEWIS MSW, LCSW, CADCII

Provider Business Mailing Address
First Line	:	46 SANDBURG DRIVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819
Country	:	US
Telephone Number	:	916-456-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	5890 NEWMAN CT
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2608
Country	:	US
Telephone Number	:	916-452-7481
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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