Provider Demographics
NPI:1881648491
Name:LEWELLYN, RONALD JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:LEWELLYN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 SOUTHWESTERN RUN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3688
Mailing Address - Country:US
Mailing Address - Phone:330-758-3819
Mailing Address - Fax:330-758-4965
Practice Address - Street 1:827 SOUTHWESTERN RUN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3688
Practice Address - Country:US
Practice Address - Phone:330-758-3819
Practice Address - Fax:330-758-4965
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4295103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000248739OtherANTHEM IND #
OH11389741OtherCAQH PROVIDER ID#
OH4295OtherOHIO LICENSE #
OH334924OtherMHS #
OH162919OtherGM/PACKARD/CIGNA
OH227276000OtherMAGELLAN MIS #
OH4295OtherOHIO LICENSE #
OHCP03076Medicare PIN