Provider Demographics
NPI:1821514571
Name:LEWIS, KEVIN K (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W 133RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-3326
Mailing Address - Country:US
Mailing Address - Phone:347-880-2967
Mailing Address - Fax:
Practice Address - Street 1:329 E 149TH ST FL 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5626
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:718-401-0108
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker