Provider Demographics
NPI:1366682197
Name:LEWIS, LISA (EDD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:EDD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 LONGWOOD AVE
Mailing Address - Street 2:MCPHS U
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5804
Mailing Address - Country:US
Mailing Address - Phone:617-879-5984
Mailing Address - Fax:
Practice Address - Street 1:179 LONGWOOD AVE
Practice Address - Street 2:MCPHS U
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-879-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1344AL101YA0400X
MA6906101YM0800X
MA9741103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health