Provider Demographics
NPI:1912364969
Name:LEWIN, MICHAEL RIESS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RIESS
Last Name:LEWIN
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 1:5500 UNIVERSITY PKWY
Mailing Address - Street 2:CALIFORNIA STATE UNIVERSITY, SAN BERNARDINO
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407
Mailing Address - Country:US
Mailing Address - Phone:909-537-7303
Mailing Address - Fax:909-537-7003
Practice Address - Street 1:1601 MONTE VISTA AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2962
Practice Address - Country:US
Practice Address - Phone:909-537-7303
Practice Address - Fax:909-537-7003
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15167103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral