Provider Demographics
NPI:1275621781
Name:LEWIS, ROBIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
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 1:600 MORRO BAY BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1935
Mailing Address - Country:US
Mailing Address - Phone:805-772-4698
Mailing Address - Fax:
Practice Address - Street 1:600 MORRO BAY BLVD
Practice Address - Street 2:STE A
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1935
Practice Address - Country:US
Practice Address - Phone:805-772-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist