Provider Demographics
NPI:1689112369
Name:LEWIS, CLAUDINE
Entity Type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:
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 1:651 E FRONT ST
Mailing Address - Street 2:APT. B
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-1420
Mailing Address - Country:US
Mailing Address - Phone:908-462-1979
Mailing Address - Fax:
Practice Address - Street 1:95 FARLEY AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1004
Practice Address - Country:US
Practice Address - Phone:908-462-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst