Provider Demographics
NPI:1174657597
Name:SB LEWIS ASSOCIATES, PC
Entity Type:Organization
Organization Name:SB LEWIS ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-651-7637
Mailing Address - Street 1:28 PARK AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9703
Mailing Address - Country:US
Mailing Address - Phone:802-651-7637
Mailing Address - Fax:802-879-5335
Practice Address - Street 1:28 PARK AVE STE 110
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9703
Practice Address - Country:US
Practice Address - Phone:802-651-7637
Practice Address - Fax:802-879-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000040101YM0800X
VT048-0000277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty