Provider Demographics
NPI:1093390684
Name:LEWIS, TINA (CMA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 NEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1545
Mailing Address - Country:US
Mailing Address - Phone:609-645-8884
Mailing Address - Fax:609-645-9780
Practice Address - Street 1:1907 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1545
Practice Address - Country:US
Practice Address - Phone:609-645-8884
Practice Address - Fax:609-645-9780
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)