Provider Demographics
NPI:1003390162
Name:LEWIS, GAIL L (PSYCH/MENTAL HEALTH)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYCH/MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37106 FAIRWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945
Mailing Address - Country:US
Mailing Address - Phone:443-614-1493
Mailing Address - Fax:
Practice Address - Street 1:37106 FAIRWAY DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945
Practice Address - Country:US
Practice Address - Phone:443-614-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELE-0000195364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health