Provider Demographics
NPI:1699830224
Name:LEWIS, MELANIE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 SILVERSIDE RD.
Mailing Address - Street 2:SUITE 36
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4911
Mailing Address - Country:US
Mailing Address - Phone:302-479-5060
Mailing Address - Fax:302-479-5061
Practice Address - Street 1:3526 SILVERSIDE RD.
Practice Address - Street 2:SUITE 36
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4911
Practice Address - Country:US
Practice Address - Phone:302-479-5060
Practice Address - Fax:302-479-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000158103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE636814Medicare PIN