Provider Demographics
NPI:1225213887
Name:LEWIS, JOSEPH LEO (BACHLOR OF SCIENCE)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEO
Last Name:LEWIS
Suffix:
Gender:M
Credentials:BACHLOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:340 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3504
Mailing Address - Country:US
Mailing Address - Phone:323-644-2026
Mailing Address - Fax:323-644-2039
Practice Address - Street 1:340 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3504
Practice Address - Country:US
Practice Address - Phone:323-644-2026
Practice Address - Fax:323-644-2039
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL0503162001101YA0400X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)