Provider Demographics
NPI:1043387012
Name:LEWANDOWSKI, MICHAEL JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:LEWANDOWSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4790 CAUGHLIN PKWY STE 173
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0907
Mailing Address - Country:US
Mailing Address - Phone:775-828-2955
Mailing Address - Fax:775-853-9888
Practice Address - Street 1:5421 KIETZKE LN
Practice Address - Street 2:STE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3027
Practice Address - Country:US
Practice Address - Phone:775-828-2955
Practice Address - Fax:775-853-9888
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY 241103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral