MEDICARE: DR. OSCAR JAMES LEWIS JR. LCSW-R, PH.D.

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	1041C0700X	Clinical Social Worker	052578	NY

General Provider Information

NPI Number	:	1326364621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSCAR JAMES LEWIS JR. LCSW-R, PH.D.

Provider Business Mailing Address
First Line	:	880 BOYNTON AVE
Second Line	:	SUITE 16L
City	:	BRONX
State	:	NY
Zip	:	10473-4649
Country	:	US
Telephone Number	:	718-530-4631
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 BOYNTON AVE
Second Line	:	SUITE 16L
City	:	BRONX
State	:	NY
Zip	:	10473-4649
Country	:	US
Telephone Number	:	718-530-4631
Fax Number	:

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

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	12/02/2015

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