Provider Demographics
NPI:1760609721
Name:LEW, BEVERLY J (MA)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:LEW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W ALAMEDA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4338
Mailing Address - Country:US
Mailing Address - Phone:818-841-0066
Mailing Address - Fax:818-841-2141
Practice Address - Street 1:4001 W ALAMEDA AVE STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4338
Practice Address - Country:US
Practice Address - Phone:818-841-0066
Practice Address - Fax:818-841-2141
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1187 & HA2614237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57911ZOtherBLUE SHIELD
CAGAU000310Medicaid
CAZZZ29947ZOtherBLUE SHIELD
CAGAU000310Medicaid