Provider Demographics
NPI:1699225961
Name:LEWIS, ANDREW HARRISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HARRISON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 KANSAS ST
Mailing Address - Street 2:APT 6
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4257
Mailing Address - Country:US
Mailing Address - Phone:619-794-5402
Mailing Address - Fax:
Practice Address - Street 1:4568 KANSAS ST
Practice Address - Street 2:APT 6
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4257
Practice Address - Country:US
Practice Address - Phone:619-794-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA721321041C0700X
MI68010995381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical