Provider Demographics
NPI:1598059297
Name:LEWIS-SENIOR, DORETTE F (ND)
Entity Type:Individual
Prefix:DR
First Name:DORETTE
Middle Name:F
Last Name:LEWIS-SENIOR
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 PLATTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3427
Mailing Address - Country:US
Mailing Address - Phone:203-374-5309
Mailing Address - Fax:203-374-6856
Practice Address - Street 1:239 PLATTSVILLE RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3427
Practice Address - Country:US
Practice Address - Phone:203-374-5309
Practice Address - Fax:203-374-6856
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000302175F00000X
174H00000X, 133NN1002X
NY461148163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support