MEDICARE: LEWIS MENTAL HEALTH COUNSELING

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	101YM0800X	Mental Health Counselor	18004672	NY

General Provider Information

NPI Number	:	1760918676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS MENTAL HEALTH COUNSELING

Provider Business Mailing Address
First Line	:	397 8TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	397 8TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3604
Country	:	US
Telephone Number	:	917-723-4685
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN LEWIS
Credential	:
Telephone Number	:	917-723-4685

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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