Provider Demographics
NPI:1508039181
Name:LEWIS, LINDA CAROL (MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CAROL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S CHERRY ST
Mailing Address - Street 2:645
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1226
Mailing Address - Country:US
Mailing Address - Phone:303-320-4425
Mailing Address - Fax:303-333-1184
Practice Address - Street 1:425 S CHERRY ST
Practice Address - Street 2:645
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1226
Practice Address - Country:US
Practice Address - Phone:303-320-4425
Practice Address - Fax:303-333-1184
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9790241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91266Medicare PIN