Provider Demographics
NPI:1033633672
Name:LEWIS, SIMONE YVONNE
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:YVONNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SIMONE
Other - Middle Name:YVONNE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10243 PISTACHIO WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2472
Mailing Address - Country:US
Mailing Address - Phone:916-617-1482
Mailing Address - Fax:
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0306
Practice Address - Country:US
Practice Address - Phone:916-537-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program