MEDICARE: MRS. CHARLOTTE LEWIS LCSW

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	LCS9115	CA

General Provider Information

NPI Number	:	1477635753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE LEWIS LCSW

Provider Business Mailing Address
First Line	:	8318 UNIVERSITY AVE
Second Line	:	SUITE A2
City	:	LA MESA
State	:	CA
Zip	:	91941-3865
Country	:	US
Telephone Number	:	619-517-8669
Fax Number	:	619-579-2187

Provider Business Practice Location Address
First Line	:	8318 UNIVERSITY AVE
Second Line	:	SUITE A2
City	:	LA MESA
State	:	CA
Zip	:	91941-3865
Country	:	US
Telephone Number	:	619-517-8669
Fax Number	:	619-579-2187

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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