Provider Demographics
NPI:1912389438
Name:LEWIS, ISHA (BLS)
Entity Type:Individual
Prefix:
First Name:ISHA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10953 SW 244TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4683
Mailing Address - Country:US
Mailing Address - Phone:786-942-7015
Mailing Address - Fax:
Practice Address - Street 1:10953 SW 244TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4683
Practice Address - Country:US
Practice Address - Phone:786-942-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker