Provider Demographics
NPI:1659417871
Name:LEW, AMY
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:LEW
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 1:10 LANGLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1972
Mailing Address - Country:US
Mailing Address - Phone:617-332-6755
Mailing Address - Fax:617-332-7863
Practice Address - Street 1:10 LANGLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1972
Practice Address - Country:US
Practice Address - Phone:617-332-6755
Practice Address - Fax:617-332-7863
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214101YM0800X
MA157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA766045OtherTUFTS ID
MALMO190OtherBLUE CROSS PIN