Provider Demographics
NPI:1619016425
Name:LEWIS, MIRIAM ASANTIWA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:ASANTIWA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28B MORTSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1316
Mailing Address - Country:US
Mailing Address - Phone:860-616-8670
Mailing Address - Fax:
Practice Address - Street 1:28B MORTSON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1316
Practice Address - Country:US
Practice Address - Phone:860-616-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical