Provider Demographics
NPI:1619332004
Name:LEWIS, EARL III (EDS, MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:EDS, MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1256
Mailing Address - Country:US
Mailing Address - Phone:201-381-6218
Mailing Address - Fax:
Practice Address - Street 1:107 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1256
Practice Address - Country:US
Practice Address - Phone:201-381-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00540700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional