Provider Demographics
NPI:1497812044
Name:LEWIN, ELISSA (MA)
Entity Type:Individual
Prefix:MS
First Name:ELISSA
Middle Name:
Last Name:LEWIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 DEAVER RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1722
Mailing Address - Country:US
Mailing Address - Phone:215-885-0753
Mailing Address - Fax:
Practice Address - Street 1:440 DEAVER RD
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1722
Practice Address - Country:US
Practice Address - Phone:215-885-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004694-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist