MEDICARE: MRS. CAROL HERMAN LEWIS M.S.

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	106H00000X	Marriage & Family Therapist	MT294	FL

General Provider Information

NPI Number	:	1346404860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL HERMAN LEWIS M.S.

Provider Business Mailing Address
First Line	:	9625 N MILITARY TRL
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5498
Country	:	US
Telephone Number	:	561-626-3592
Fax Number	:	561-626-3592

Provider Business Practice Location Address
First Line	:	1415 N K ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-1816
Country	:	US
Telephone Number	:	561-582-6691
Fax Number	:	561-582-5161

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	03/17/2018

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