Provider Demographics
NPI:1851365175
Name:LEWIS, ALFRED J (LCSW R)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SCRANTON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2917
Mailing Address - Country:US
Mailing Address - Phone:516-884-7736
Mailing Address - Fax:516-594-4053
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-884-7736
Practice Address - Fax:516-594-4053
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05183011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N68751Medicare ID - Type Unspecified