Provider Demographics
NPI:1063471027
Name:LEWIS, GREGORY N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BLANCHARD CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2037
Mailing Address - Country:US
Mailing Address - Phone:630-653-2300
Mailing Address - Fax:630-653-2895
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2039
Practice Address - Country:US
Practice Address - Phone:630-653-2300
Practice Address - Fax:630-653-2895
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004107103T00000X
IL071-004107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215643OtherBLUE CROSS BLUE SHIELD
ILCA2795Medicare PIN
ILK05737Medicare PIN
IL200028Medicare PIN