Provider Demographics
NPI:1477586626
Name:LEWIN, MYRNA N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:N
Last Name:LEWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16595 LAKE CIRCLE DR APT 234
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5723
Mailing Address - Country:US
Mailing Address - Phone:239-560-9902
Mailing Address - Fax:
Practice Address - Street 1:16595 LAKE CIRCLE DR APT 234
Practice Address - Street 2:SUITE #3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5723
Practice Address - Country:US
Practice Address - Phone:239-560-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW73061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11584916OtherCAQH
FLZ094XOtherANTHEM BLUE CROSS
FLU6765Medicare ID - Type Unspecified?