Provider Demographics
NPI:1689616856
Name:LEWIS, MEGAN B (PSYD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 JEFFERSON ST
Mailing Address - Street 2:STE 201
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2358
Mailing Address - Country:US
Mailing Address - Phone:619-631-0128
Mailing Address - Fax:619-631-0153
Practice Address - Street 1:2910 JEFFERSON ST
Practice Address - Street 2:STE 201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2358
Practice Address - Country:US
Practice Address - Phone:619-631-0128
Practice Address - Fax:619-631-0153
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18875Medicare UPIN