Provider Demographics
NPI:1083205595
Name:KEYNDRA LEWIS LMFT LLC
Entity Type:Organization
Organization Name:KEYNDRA LEWIS LMFT LLC
Other - Org Name:KEYNDRA LEWIS LMFT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-449-1123
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:CT
Mailing Address - Zip Code:06444-0157
Mailing Address - Country:US
Mailing Address - Phone:475-329-0645
Mailing Address - Fax:
Practice Address - Street 1:49 BROAD ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-4201
Practice Address - Country:US
Practice Address - Phone:475-329-0645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty