Provider Demographics
NPI:1730652819
Name:LEWIS, SANDRA FAY (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FAY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-7913
Mailing Address - Country:US
Mailing Address - Phone:775-888-6610
Mailing Address - Fax:775-888-4904
Practice Address - Street 1:2225 CIVIC CENTER DR STE 224
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6332
Practice Address - Country:US
Practice Address - Phone:702-214-5948
Practice Address - Fax:702-214-9430
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8226-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1730652819Medicaid