Provider Demographics
NPI:1225047137
Name:LEWIS, ROBIN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:J
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 1:505 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1150
Mailing Address - Country:US
Mailing Address - Phone:757-497-4965
Mailing Address - Fax:757-497-4197
Practice Address - Street 1:505 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1150
Practice Address - Country:US
Practice Address - Phone:757-497-4965
Practice Address - Fax:757-497-4197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA076708OtherBLUE CROSS
VA080905OtherSENTARA
VA7708173Medicaid
VA080905OtherSENTARA