MEDICARE: JENNA LEWIS M.S., BCBA, LBA

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114412327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LEWIS M.S., BCBA, LBA

Provider Business Mailing Address
First Line	:	4108 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2754
Country	:	US
Telephone Number	:	850-628-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	4108 E PARHAM RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2754
Country	:	US
Telephone Number	:	850-628-0949
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/29/2018

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