Basic Information
| Provider Information | |||||||||
| NPI: | 1487091153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | L.M.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2449 97TH ST | ||||||||
| Address2: | |||||||||
| City: | EAST ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113691219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474766682 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1329 BEACH CHANNEL DR | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116913211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183376850 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2013 | ||||||||
| LastUpdateDate: | 06/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 088393 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.