Provider Demographics
NPI:1659502383
Name:LEWIS, EUGENIE MAY (MSW, LCSW, MHSA)
Entity Type:Individual
Prefix:MS
First Name:EUGENIE
Middle Name:MAY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW, LCSW, MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 CURTIS AVE
Mailing Address - Street 2:B
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2006
Mailing Address - Country:US
Mailing Address - Phone:310-386-0732
Mailing Address - Fax:
Practice Address - Street 1:2202 CURTIS AVE
Practice Address - Street 2:B
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2006
Practice Address - Country:US
Practice Address - Phone:310-386-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25616101YM0800X, 101YP2500X, 101YS0200X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25616OtherBOARD OF BEHAVIORAL SCIENCES