Provider Demographics
NPI:1386842482
Name:LEWIS, LISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
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 1:661 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1049
Mailing Address - Country:US
Mailing Address - Phone:724-627-4309
Mailing Address - Fax:
Practice Address - Street 1:501 W HIGH ST
Practice Address - Street 2:CORNERSTONE CARE
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-7209
Practice Address - Country:US
Practice Address - Phone:724-627-4309
Practice Address - Fax:724-627-0726
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016257103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical