Provider Demographics
NPI:1003034554
Name:LEWIN, MELVYN MATTHEW (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:MATTHEW
Last Name:LEWIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 YARMOUTH RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2654
Mailing Address - Country:US
Mailing Address - Phone:310-377-1198
Mailing Address - Fax:310-791-9627
Practice Address - Street 1:716 YARMOUTH RD
Practice Address - Street 2:SUITE D
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2654
Practice Address - Country:US
Practice Address - Phone:310-377-1198
Practice Address - Fax:310-791-9627
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical