MEDICARE: SUSAN LEWIS AMFT, JD

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1124697701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LEWIS AMFT, JD

Provider Business Mailing Address
First Line	:	PO BOX 2013
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95031-2013
Country	:	US
Telephone Number	:	408-409-4167
Fax Number	:

Provider Business Practice Location Address
First Line	:	15885 LOS GATOS ALMADEN RD
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-3803
Country	:	US
Telephone Number	:	408-393-3518
Fax Number	:

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

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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