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NPI Code Detail

MEDICARE: MS. AMANDA RUTH LEWIS LGSW

MEDICARE: MS. AMANDA RUTH LEWIS LGSW
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
1104100000XSocial WorkerLG200001672DC

General Provider Information

NPI Number : 1255051736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA RUTH LEWIS LGSW
Provider Business Mailing Address
First Line : 4040 E CAPITOL ST NE APT E44
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-3322
Country : US
Telephone Number : 703-589-0239
Fax Number :
Provider Business Practice Location Address
First Line : 6010 EXECUTIVE BLVD STE 206
Second Line :
City : ROCKVILLE
State : MD
Zip : 20852-3822
Country : US
Telephone Number : 240-447-7772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2022
Last Update Date : 09/02/2022

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