Basic Information
| Provider Information | |||||||||
| NPI: | 1225213887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | LEO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BACHLOR OF SCIENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 N MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442026 | ||||||||
| FaxNumber: | 3236442039 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 N MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900043504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236442026 | ||||||||
| FaxNumber: | 3236442039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | L0503162001 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.