Provider Demographics
NPI:1851714380
Name:LEW, GYPSY MAY (LCMHC)
Entity Type:Individual
Prefix:
First Name:GYPSY
Middle Name:MAY
Last Name:LEW
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1550
Mailing Address - Country:US
Mailing Address - Phone:802-498-8481
Mailing Address - Fax:
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1550
Practice Address - Country:US
Practice Address - Phone:802-498-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0093942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health