Provider Demographics
NPI:1518021583
Name:LEWIS, CARMELITA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMELITA
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 E RIDGE MEWS
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1549
Mailing Address - Country:US
Mailing Address - Phone:215-499-1255
Mailing Address - Fax:215-860-5819
Practice Address - Street 1:1701 LANGHORNE NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1003
Practice Address - Country:US
Practice Address - Phone:215-499-1255
Practice Address - Fax:215-860-7819
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005658L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35S100242400OtherLICENSE