Provider Demographics
NPI:1770503542
Name:LEWIS, SYMONE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:SYMONE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:SYMONE
Other - Middle Name:
Other - Last Name:NORDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:75 EXECUTIVE DR STE 337
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8152
Mailing Address - Country:US
Mailing Address - Phone:331-707-8623
Mailing Address - Fax:
Practice Address - Street 1:75 EXECUTIVE DR STE 337
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8152
Practice Address - Country:US
Practice Address - Phone:331-707-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-007064OtherLIC. CLINICAL PSYCHOLOGIS