MEDICARE: KASEY J LEWANDOWSKI LPCC

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	101YP2500X	Professional Counselor	16112	CA

General Provider Information

NPI Number	:	1336999192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY J LEWANDOWSKI LPCC

Provider Business Mailing Address
First Line	:	3773 32ND ST APT 5
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3752
Country	:	US
Telephone Number	:	414-405-2759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3728
Country	:	US
Telephone Number	:	414-405-2759
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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