Provider Demographics
NPI:1073633210
Name:LEWIS, MARYLYNN-MIMI (MSW, LCSW, CADCII)
Entity Type:Individual
Prefix:MS
First Name:MARYLYNN-MIMI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW, LCSW, CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SANDBURG DRIVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-456-4969
Mailing Address - Fax:
Practice Address - Street 1:5890 NEWMAN CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2608
Practice Address - Country:US
Practice Address - Phone:916-452-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 204271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical