Provider Demographics
NPI:1083332266
Name:LEWIS, ANDRE COOLIDGE (MHP)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:COOLIDGE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S SALCEDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-2854
Mailing Address - Country:US
Mailing Address - Phone:504-821-0053
Mailing Address - Fax:504-821-0054
Practice Address - Street 1:1608 S SALCEDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2854
Practice Address - Country:US
Practice Address - Phone:504-821-0053
Practice Address - Fax:504-821-0054
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA003599870171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator