MEDICARE: ERICKA LEWIS MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1235540907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA LEWIS MSW

Provider Business Mailing Address
First Line	:	2116 COLD SPRING RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-2319
Country	:	US
Telephone Number	:	317-783-4003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 S STATE AVE
Second Line	:	1404 S. STATE AVE
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2009
Country	:	US
Telephone Number	:	317-783-4003
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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