Provider Demographics
NPI:1821342155
Name:LEWIS, MARTHA E (EDUCATION)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:EDUCATION
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:E
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDUCATION
Mailing Address - Street 1:1840 BARREL OAK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-5087
Mailing Address - Country:US
Mailing Address - Phone:702-572-3560
Mailing Address - Fax:702-647-0861
Practice Address - Street 1:1840 BARREL OAK AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-5087
Practice Address - Country:US
Practice Address - Phone:702-572-3560
Practice Address - Fax:702-647-0861
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst