MEDICARE: VINER S LEWIS

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

General Provider Information

NPI Number	:	1568139103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINER S LEWIS

Provider Business Mailing Address
First Line	:	1500 GATEWAY BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 PLANTATION RD
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32504-4206
Country	:	US
Telephone Number	:	850-462-1611
Fax Number	:	850-462-1612

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

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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Directions to “ VINER S LEWIS ” Practice Location

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