Provider Demographics
NPI:1659443232
Name:KELLEY-LEWIS, SABRENIA
Entity Type:Individual
Prefix:MRS
First Name:SABRENIA
Middle Name:
Last Name:KELLEY-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 1:2843 JOSEPH CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9228
Mailing Address - Country:US
Mailing Address - Phone:407-359-2795
Mailing Address - Fax:
Practice Address - Street 1:2843 JOSEPH CIR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9228
Practice Address - Country:US
Practice Address - Phone:407-359-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 5896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health