Provider Demographics
NPI:1558911883
Name:LEWIS, JOSEPH LEITH ANTHONY (RBT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LEITH ANTHONY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 WINDWOOD DR NE APT 103
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-7592
Mailing Address - Country:US
Mailing Address - Phone:321-720-5941
Mailing Address - Fax:
Practice Address - Street 1:130 N TROPICAL TRL
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4737
Practice Address - Country:US
Practice Address - Phone:321-961-7831
Practice Address - Fax:407-960-3009
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst