MEDICARE: ANNETTE LEWIS LCSW 102342

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	102342	CA
2	101YM0800X	Mental Health Counselor
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518141241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE LEWIS LCSW 102342

Provider Business Mailing Address
First Line	:	84 BROADWAY
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1910
Country	:	US
Telephone Number	:	510-231-7812
Fax Number	:	510-231-7810

Provider Business Practice Location Address
First Line	:	186 BROADWAY
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1949
Country	:	US
Telephone Number	:	510-367-6350
Fax Number	:

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	07/29/2021

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