Provider Demographics
NPI:1861821548
Name:LEWIS, MAILYNN
Entity Type:Individual
Prefix:
First Name:MAILYNN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4545
Mailing Address - Country:US
Mailing Address - Phone:718-735-5966
Mailing Address - Fax:718-735-5178
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4545
Practice Address - Country:US
Practice Address - Phone:718-735-5966
Practice Address - Fax:718-735-5178
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health