Provider Demographics
NPI:1437534237
Name:LEWIS, MARIAH (LCSW, CEO)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW, CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W FLAGLER ST STE 900
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1807
Mailing Address - Country:US
Mailing Address - Phone:850-305-1894
Mailing Address - Fax:
Practice Address - Street 1:66 W FLAGLER ST STE 900 # 8384
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3313
Practice Address - Country:US
Practice Address - Phone:850-359-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW182971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1437534237Medicaid