Provider Demographics
NPI:1073596045
Name:BREITNER, LEWIS S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:S
Last Name:BREITNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3316
Mailing Address - Country:US
Mailing Address - Phone:413-562-9199
Mailing Address - Fax:413-527-6766
Practice Address - Street 1:466 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3316
Practice Address - Country:US
Practice Address - Phone:413-562-9199
Practice Address - Fax:413-527-6766
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA559101YA0400X
MA2143103TC0700X
MA245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA03000050Medicaid
MA10805OtherPSYCHOLOGIST
MABRW50574OtherPTAN
MABRW50574Medicare ID - Type UnspecifiedPSYCHOLOGIST