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NPI Code Detail

MEDICARE: DR. SHANNON LEWIS PSY.D.

MEDICARE: DR. SHANNON LEWIS PSY.D.
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
1103TC0700XClinical Psychologist9667MA

General Provider Information

NPI Number : 1811206121
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON LEWIS PSY.D.
Provider Business Mailing Address
First Line : 450 PEARL ST STE 3
Second Line :
City : STOUGHTON
State : MA
Zip : 02072-1617
Country : US
Telephone Number : 781-318-3177
Fax Number :
Provider Business Practice Location Address
First Line : 450 PEARL ST STE 3
Second Line :
City : STOUGHTON
State : MA
Zip : 02072-1617
Country : US
Telephone Number : 781-318-3177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2010
Last Update Date : 02/07/2022

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