Provider Demographics
NPI:1679800213
Name:LEWIS, JO ANN V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JO ANN
Middle Name:V
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KELLY AVE
Mailing Address - Street 2:PO BOX 143
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3658
Mailing Address - Country:US
Mailing Address - Phone:631-234-1998
Mailing Address - Fax:
Practice Address - Street 1:159 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4172
Practice Address - Country:US
Practice Address - Phone:631-439-4300
Practice Address - Fax:631-439-4319
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0545531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical