Provider Demographics
NPI:1790965390
Name:LEWIS, LINDA S (MSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 COPPER VW
Mailing Address - Street 2:SUITE 118
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7098
Mailing Address - Country:US
Mailing Address - Phone:231-935-0792
Mailing Address - Fax:231-935-1886
Practice Address - Street 1:4020 COPPER VW
Practice Address - Street 2:SUITE 118
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7098
Practice Address - Country:US
Practice Address - Phone:231-935-0792
Practice Address - Fax:231-935-1886
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010141221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical