Provider Demographics
NPI:1598737470
Name:LEWIS, NORAH WENDY
Entity Type:Individual
Prefix:MS
First Name:NORAH
Middle Name:WENDY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NORAH
Other - Middle Name:WENDY
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:661 MASSACHUSETTS AVE
Mailing Address - Street 2:3
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5000
Mailing Address - Country:US
Mailing Address - Phone:781-643-9099
Mailing Address - Fax:781-643-6445
Practice Address - Street 1:661 MASSACHUSETTS AVE
Practice Address - Street 2:3
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5000
Practice Address - Country:US
Practice Address - Phone:781-643-9099
Practice Address - Fax:781-643-6445
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALEP30029Medicare ID - Type Unspecified
MA103524Medicare UPIN
MALEP06394Medicare UPIN