Provider Demographics
NPI:1144386269
Name:LEWIS, NONA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NONA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 COOL TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:NY
Mailing Address - Zip Code:12075-1245
Mailing Address - Country:US
Mailing Address - Phone:518-672-4537
Mailing Address - Fax:518-672-4537
Practice Address - Street 1:72 COOL TIMBER RD
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-1245
Practice Address - Country:US
Practice Address - Phone:518-672-4537
Practice Address - Fax:518-672-4537
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01241258Medicaid
NYV49181Medicare ID - Type Unspecified