MEDICARE: AJANAE L LEWIS ATR-BC, LCAT

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	221700000X	Art Therapist	002923	NY

General Provider Information

NPI Number	:	1114782778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJANAE L LEWIS ATR-BC, LCAT

Provider Business Mailing Address
First Line	:	417 MYRTLE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-2426
Country	:	US
Telephone Number	:	917-284-8366
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 CARLTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-2201
Country	:	US
Telephone Number	:	718-625-4545
Fax Number	:

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

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	02/13/2024

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