Provider Demographics
NPI:1629089057
Name:LEWIS, STEWART DOUGLAS (PHD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:DOUGLAS
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 YACHT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8317
Mailing Address - Country:US
Mailing Address - Phone:904-384-3985
Mailing Address - Fax:
Practice Address - Street 1:2120 CORPORATE SQUARE BLVD
Practice Address - Street 2:SUITE 29
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0306
Practice Address - Country:US
Practice Address - Phone:904-651-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 2839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist