Provider Demographics
NPI:1376842336
Name:GUERRERO-LEWIS, NORMA
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:GUERRERO-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 4TH ST STE 234
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3444
Mailing Address - Country:US
Mailing Address - Phone:310-508-2664
Mailing Address - Fax:
Practice Address - Street 1:5807 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5303
Practice Address - Country:US
Practice Address - Phone:323-234-4445
Practice Address - Fax:323-234-4477
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91063106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist