MEDICARE: MISS STACY NICOLE 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	106S00000X	Behavior Technician		CT

General Provider Information

NPI Number	:	1851256465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STACY NICOLE LEWIS

Provider Business Mailing Address
First Line	:	350 FAIRWAY DRIVE
Second Line	:	101
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	360 BLOOMFIELD AVE
Second Line	:	SUITE 301
City	:	WINDSOR
State	:	CT
Zip	:	06095
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ MISS STACY NICOLE LEWIS ” Practice Location

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