MEDICARE: MS. KARENSA GAYLE LEWIS L.C.S.W.

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	991989	CO

General Provider Information

NPI Number	:	1407907934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARENSA GAYLE LEWIS L.C.S.W.

Provider Business Mailing Address
First Line	:	2864 S CIRCLE DR
Second Line	:	STE. 500
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4114
Country	:	US
Telephone Number	:	719-531-9211
Fax Number	:	719-577-9627

Provider Business Practice Location Address
First Line	:	2864 S CIRCLE DR
Second Line	:	STE. 500
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4114
Country	:	US
Telephone Number	:	719-531-9211
Fax Number	:	719-577-9627

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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