MEDICARE: GEORGE RAYMOND LEWIS LISW

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	I-0007	NM

General Provider Information

NPI Number	:	1518193648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE RAYMOND LEWIS LISW

Provider Business Mailing Address
First Line	:	1018 N PLAINS PARK DR
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-2516
Country	:	US
Telephone Number	:	575-624-1780
Fax Number	:	575-624-2033

Provider Business Practice Location Address
First Line	:	1000 E 18TH ST
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-7532
Country	:	US
Telephone Number	:	575-624-1780
Fax Number	:	575-624-1780

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

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	04/05/2026

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