Basic Information
| Provider Information | |||||||||
| NPI: | 1396286464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21975 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403214281 | ||||||||
| FaxNumber: | 5403214282 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CULPEPER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 227013210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408254557 | ||||||||
| FaxNumber: | 5408254566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2017 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904010651 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | Q61316A | 01 | VA | MEDICARE | OTHER | 0904010651 | 01 | VA | LICENSE | OTHER | 1396286464 | 05 | VA | MEDICAID |