Provider Demographics
NPI:1487197208
Name:LEWIS CENTER
Entity Type:Organization
Organization Name:LEWIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:301-759-2813
Mailing Address - Street 1:111 S GEORGE ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3087
Mailing Address - Country:US
Mailing Address - Phone:301-759-2813
Mailing Address - Fax:301-759-2813
Practice Address - Street 1:111 S GEORGE ST
Practice Address - Street 2:SUITE 15
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3087
Practice Address - Country:US
Practice Address - Phone:301-759-2813
Practice Address - Fax:301-759-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02910103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBA29OtherCAREFIRST
MD458143000OtherMAGELLAN
MD313101700Medicaid
MD458143000OtherMAGELLAN