Provider Demographics
NPI:1003046970
Name:LEWIS, DAVID TIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID TIM
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MARKET ST STE 1208
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2122
Mailing Address - Country:US
Mailing Address - Phone:415-350-9611
Mailing Address - Fax:
Practice Address - Street 1:703 MARKET ST STE 1208
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2122
Practice Address - Country:US
Practice Address - Phone:415-350-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical