Provider Demographics
NPI:1306184247
Name:RUTH E LEWIS PHD LLC
Entity Type:Organization
Organization Name:RUTH E LEWIS PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PYSCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-483-3329
Mailing Address - Street 1:742 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4712
Mailing Address - Country:US
Mailing Address - Phone:781-483-3329
Mailing Address - Fax:855-893-1289
Practice Address - Street 1:742 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4712
Practice Address - Country:US
Practice Address - Phone:781-483-3329
Practice Address - Fax:855-893-1289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTH E. LEWIS PHD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7359251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110022442AMedicaid
MAW50379Medicare PIN