Basic Information
| Provider Information | |||||||||
| NPI: | 1043353295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | SHERRIDELL | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5117 BACCICH ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701226212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042826188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 719 ELYSIAN FIELDS AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701178511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049428101 | ||||||||
| FaxNumber: | 5049428242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 11/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 3406 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 1958C | AL | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.