Provider Demographics
NPI:1629255658
Name:LEWIS, KATHERINE BLAKE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BLAKE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 1/2 OXFORD ST APT 5
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1564
Mailing Address - Country:US
Mailing Address - Phone:415-302-9941
Mailing Address - Fax:
Practice Address - Street 1:366 SOMERVILLE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2919
Practice Address - Country:US
Practice Address - Phone:617-628-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist