Provider Demographics
NPI:1033375985
Name:LEWIS, LAURIE REIDER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:REIDER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-4002
Mailing Address - Country:US
Mailing Address - Phone:443-262-5804
Mailing Address - Fax:
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-4002
Practice Address - Country:US
Practice Address - Phone:443-262-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04904103T00000X
NY018253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist