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NPI Code Detail

MEDICARE: DR. LISA LEWIS PHD

MEDICARE: DR. LISA LEWIS PHD
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
1103G00000XClinical NeuropsychologistPS016257PA
2103TC0700XClinical PsychologistPS016257PA

General Provider Information

NPI Number : 1386842482
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA LEWIS PHD
Provider Business Mailing Address
First Line : 661 ROSS ST
Second Line :
City : WAYNESBURG
State : PA
Zip : 15370-1049
Country : US
Telephone Number : 724-627-4309
Fax Number :
Provider Business Practice Location Address
First Line : 501 W HIGH ST
Second Line : CORNERSTONE CARE
City : WAYNESBURG
State : PA
Zip : 15370-7209
Country : US
Telephone Number : 724-627-4309
Fax Number : 724-627-0726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2007
Last Update Date : 04/26/2012

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