MEDICARE: SUSANNA REBECCA LEWIS LCSW-C

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	18021	MD

General Provider Information

NPI Number	:	1437688173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNA REBECCA LEWIS LCSW-C

Provider Business Mailing Address
First Line	:	200 WASHINGTON AVENUE
Second Line	:	FLOOR 5 #35
City	:	TOWSON
State	:	MD
Zip	:	21204-4718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WASHINGTON AVENUE
Second Line	:	FLOOR 5 #35
City	:	TOWSON
State	:	MD
Zip	:	21204-4718
Country	:	US
Telephone Number	:	443-454-5787
Fax Number	:

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

Provider Enumeration Date	:	06/07/2017
Last Update Date	:	09/20/2025

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