MEDICARE: DR. ROXANNE ANGELA LEWIS PHD

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	103G00000X	Clinical Neuropsychologist	3428	OH
2	103TC0700X	Clinical Psychologist	3574	MA
3	103TC0700X	Clinical Psychologist	60009283	WA

General Provider Information

NPI Number	:	1124049556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANNE ANGELA LEWIS PHD

Provider Business Mailing Address
First Line	:	387 COUNTY LINE RD W
Second Line	:	STE 225
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-6918
Country	:	US
Telephone Number	:	614-985-3649
Fax Number	:	614-985-3601

Provider Business Practice Location Address
First Line	:	200 E CAMPUS VIEW BLVD
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4678
Country	:	US
Telephone Number	:	614-985-3649
Fax Number	:	614-985-3601

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	04/27/2017

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