Provider Demographics
NPI:1093833436
Name:LEWIS, SHARON (LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1900
Mailing Address - Country:US
Mailing Address - Phone:330-945-7100
Mailing Address - Fax:330-945-4305
Practice Address - Street 1:2795 FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1900
Practice Address - Country:US
Practice Address - Phone:330-945-7100
Practice Address - Fax:330-945-4305
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933765101YA0400X
OHS0021798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10024Medicaid
OH10034Medicaid