Provider Demographics
NPI:1790169985
Name:LEWIS, LINDSEY MARIE (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3652 MICHELSON DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1727
Mailing Address - Country:US
Mailing Address - Phone:949-474-1493
Mailing Address - Fax:
Practice Address - Street 1:18008 SKY PARK CIR
Practice Address - Street 2:SUITE #110
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6433
Practice Address - Country:US
Practice Address - Phone:949-474-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18685103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst