Provider Demographics
NPI:1689218703
Name:LEWANDOWSKI, TIA SHAE
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:SHAE
Last Name:LEWANDOWSKI
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 1:78 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-1318
Mailing Address - Country:US
Mailing Address - Phone:413-579-7572
Mailing Address - Fax:413-277-0537
Practice Address - Street 1:78 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1318
Practice Address - Country:US
Practice Address - Phone:413-579-7572
Practice Address - Fax:413-277-0537
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor