Provider Demographics
NPI:1033206008
Name:LEWIS, TERRI L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1052
Mailing Address - Country:US
Mailing Address - Phone:207-990-0091
Mailing Address - Fax:207-990-3388
Practice Address - Street 1:23 WATER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6364
Practice Address - Country:US
Practice Address - Phone:207-990-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC57721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
362976OtherMHN
048721OtherANTHEM BCBS
ME303370099Medicaid
362976OtherMHN