MEDICARE: MS. MELISSA 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	103TS0200X	School Psychologist		OH

General Provider Information

NPI Number	:	1922418078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA LEWIS

Provider Business Mailing Address
First Line	:	3665 MONTICELLO BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3665 MONTICELLO BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1581
Country	:	US
Telephone Number	:	216-320-3707
Fax Number	:

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

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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